Emergency One-Stage Robotic Surgery for Congenital Biliary Dilatation With Bile Duct Perforation in a Pediatric Patient: A Case Report.

Bile duct perforation is a rare, serious complication of congenital biliary dilatation (CBD). While traditionally managed with a two-stage surgical approach, recent reports suggest that one-stage, minimally invasive approaches may be feasible. We present the case of a 13-month-old female who developed bile duct perforation associated with a protein plug in the common channel. Following the correction of coagulopathy, emergency robotic surgery was performed, including bile duct excision and Roux-en-Y hepaticojejunostomy. Despite significant adhesions and an anatomical anomaly in which the right hepatic artery coursed anterior to the common hepatic duct, robotic dissection and reconstruction were safely completed. The postoperative course was uneventful, and the patient was discharged. This report highlights the feasibility and potential advantages of one-stage robotic surgery for CBD with perforation, even in the presence of active inflammation and vascular anomalies. Similar cases must be reported and evaluated to understand the indications and limitations of this approach.