Combined robotic cholecystoduodenal fistula repair and hepaticoduodenostomy with bile duct exploration in a patient with recurrent choledocholithiasis and prior Bouveret syndrome: a case report.

Background: Cholecystoenteric fistula (CEF) is a rare complication of gallstone disease. The most common type is cholecystoduodenal fistula (CDF). Preoperative diagnosis has historically been challenging, but advances in imaging have improved detection rates. While open repair of CDF is considered the standard operative approach, the use of minimally invasive techniques, either laparoscopic or robotic approaches, has steadily increased. Case Description: We report the case of a 71-year-old woman with a CDF secondary to a previous subtotal fenestrated cholecystectomy. The condition was further complicated by recurrent choledocholithiasis (RC). Both conditions were managed in a single-stage robotic procedure, including a completion cholecystectomy, bile duct exploration, removal of the biliary calculi, and end-to-side hepaticoduodenostomy over the CDF duodenal defect. To our knowledge, this is the first reported case in which both conditions were addressed simultaneously using a biliary bypass on a robotic platform. At the 3-month follow-up, the patient had complete resolution of symptoms, supporting the compatibility of our approach with the existing literature on robotic management of CDF and RC. Conclusions: Given the intrinsic benefits of the robotic approach and growing body of supporting evidence, we report the feasibility of this approach in the management of CDF and RC.