机器人辅助胆肠再吻合治疗胆肠吻合术后良性胆道狭窄:单中心技术经验与手术策略OA

Benign biliary stricture following bilioenteric anastomosis is an important late complication of biliary reconstruction and may result in cholestasis,recurrent cholangitis,intrahepatic bile duct stones,and secondary hepatic dysfunction.For patients with failed or unsuitable endoscopic or percutaneous interventions,particularly those with severe cicatricial strictures,high hilar or multifocal biliary involvement,or complex intrahepatic biliary disease,redo bilioenteric anastomosis remains an important option for restoring durable biliary drainage.With its three-dimensional magnified visualization,wristed instruments,and enhanced suturing capability,robotic surgery provides a potential minimally invasive approach for complex biliary reconstruction.Based on the relevant literature and our institutional experience,we systematically summarize the key aspects of robot-assisted redo bilioenteric anastomosis for benign biliary strictures after bilioenteric anastomosis,including patient selection,preoperative assessment,trocar placement,adhesiolysis,hilar dissection,bile duct incision and ductoplasty,basin-like bilioenteric drainage reconstruction,perioperative management,and postoperative follow-up.Particular attention is given to technical principles for reducing anastomotic tension,preserving bile duct vascularity,creating a wide and effective drainage surface,and achieving precise mucosa-to-mucosa apposition during complex biliary reconstruction.Robot-assisted redo bilioenteric anastomosis may provide a feasible minimally invasive reconstructive option for selected patients with complex benign biliary strictures after bilioenteric anastomosis.Its application should,however,be based on strict patient selection,comprehensive preoperative assessment,and adequate expertise in complex biliary reconstruction,while its long-term efficacy and potential advantages over other surgical approaches require further validation in high-quality clinical studies.