Robotic Whipple for Abnormal Pancreaticobiliary Junction With Recurrent Acute Pancreatitis: A Case Report

Pancreaticobiliary maljunction (PBM) is a congenital anomaly that predisposes patients to recurrent pancreatitis, choledocholithiasis, and an increased risk of biliary tract malignancy. In patients without biliary dilatation, standard management typically consists of cholecystectomy with endoscopic biliary decompression. However, management can be challenging in patients with refractory recurrent pancreatitis, indeterminate strictures, or progressive ductal changes. We describe a 62-year-old woman with PBM who presented with recurrent acute pancreatitis despite undergoing cholecystectomy, biliary sphincterotomy, and multiple endoscopic retrograde cholangiopancreatography (ERCP) interventions, including stent placements, choledocholithiasis extraction, and SpyGlass-directed biopsies, all of which were negative for malignancy. Over three years, she experienced multiple admissions for pancreatitis, progressive dilation of the common bile duct, and a persistent distal common bile duct stricture. Owing to ongoing symptoms and concern for occult malignancy, she underwent robotic-assisted pancreatoduodenectomy. Intraoperatively, bile-stained stones were identified in the pancreatic duct. Final pathology demonstrated chronic pancreatitis and fibrosis without malignancy. Her postoperative recovery was uneventful, with discharge on postoperative day four and complete resolution of pancreatitis symptoms at several months of follow-up. This case illustrates a rare scenario of PBM-associated recurrent pancreatitis refractory to cholecystectomy and ERCP decompression. The presence of a distal intrapancreatic stricture likely contributed to ongoing symptoms, and the potential for occult malignancy remained despite multiple negative endoscopic biopsies. Robotic pancreatoduodenectomy provided both diagnostic and therapeutic benefits, permitting en bloc resection of the stricture and associated bile duct. Contemporary evidence suggests that robotic pancreatoduodenectomy offers perioperative advantages over open surgery, including reduced blood loss, fewer wound infections, and shorter hospital stays, albeit with longer operative times. These findings align with the favorable course in our patient, who recovered rapidly and remains symptom-free. Robotic pancreatoduodenectomy can be considered a definitive treatment option in select patients with PBM and refractory recurrent pancreatitis, especially in the presence of indeterminate strictures. This approach provides both symptom relief and diagnostic certainty, while offering perioperative benefits compared with open surgery.