Robotic Biliary Stricturoplasty and Roux-en-Y Hepaticojejunostomy After Hepatic Artery Infusion Pump Injury

Area of Science:

• Minimally invasive surgery
• Hepatobiliary surgery
• Robotic surgery

Background:

• Hepatic artery infusion pump (HAIP) chemotherapy with floxuridine/dexamethasone is used for stage 4 colorectal liver metastasis, potentially converting unresectable disease to resectable.
• Biliary sclerosis is a known complication of HAIP treatment, occurring in 2-5.5% of patients.
• Dominant biliary strictures can arise, offering an opportunity for surgical intervention after endoscopic treatment failure.

Observation:

• A 68-year-old woman with stage 4 colorectal liver metastasis developed obstructive jaundice and recurrent cholangitis after HAIP treatment.
• Multiple endoscopic and percutaneous attempts to dilate a dominant right hepatic duct stricture failed.
• The patient had undergone prior surgery and HAIP therapy, with complete radiological resolution of liver metastases.

Findings:

• A robotic biliary stricturoplasty and Roux-en-Y (RY) hepaticojejunostomy were successfully performed.
• The procedure involved meticulous dissection, division of fibrosis, and reconstruction of the biliary tree.
• Operative time was 4 hours with minimal blood loss; the patient recovered well and remained disease-free at 1-year follow-up.

Implications:

• Robotic biliary stricturoplasty with RY hepaticojejunostomy is a safe and feasible option for managing biliary sclerosis post-HAIP chemotherapy.
• This minimally invasive approach can effectively treat complex biliary strictures when endoscopic methods fail.
• Expertise in robotic hepatobiliary surgery is crucial for successful outcomes in these challenging cases.