Robotic Biliary Resection for Type I Choledochal Cyst With Dual Hepaticojejunostomy

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Techniques
• Digestive System Anatomy

Background:

• Bile duct surgery requires precise reconstruction techniques.
• Roux-en-Y gastrojejunostomy is a common procedure for various gastrointestinal conditions.
• Ensuring adequate limb length and correct anastomosis is crucial for surgical success.

Purpose of the Study:

• To describe the detailed steps of constructing a 60 cm Roux limb.
• To illustrate the antecolic transposition of the Roux limb to the porta hepatis.
• To confirm the absence of malignancy in the distal bile duct prior to reconstruction.

Main Methods:

• Isolation and transection of the distal bile duct with frozen section analysis.
• Identification and transection of the proximal jejunum 40 cm from the ligamentum of Treitz.
• Creation of a 60 cm Roux limb with a side-to-side stapled jejunojejunostomy and antecolic transposition.

Main Results:

• Successful isolation and transection of the distal bile duct confirmed no malignancy.
• A 60 cm Roux limb was accurately constructed.
• The Roux limb was successfully transposed antecolically to the porta hepatis.

Conclusions:

• The described method provides a reproducible technique for Roux limb construction in biliary surgery.
• Confirmation of negative margins via frozen section is a critical safety step.
• Antecolic transposition facilitates efficient reconstruction of the biliary pathway.