A 49-year-old patient with a history of laparoscopic cholecystectomy presented with recurrent cholangitis and persistent biliary symptoms despite multiple endoscopic interventions. Prior ERCP procedures demonstrated recurrent common bile duct stones and a large retained cystic duct remnant containing stones, which was not amenable to endoscopic clearance due to the narrow and tortuous cystic duct–common bile duct junction.

Cross-sectional imaging and endoscopic studies demonstrated a markedly dilated cystic duct remnant measuring approximately 3–4 cm with a large retained stone, functioning as a reservoir for recurrent biliary stasis and stone formation. This anatomy is a recognized cause of post-cholecystectomy syndrome, particularly when the cystic duct stump is long or when surgical clips are placed proximally.

The patient underwent robotic diagnostic laparoscopy, extensive adhesiolysis, intraoperative ultrasound, indocyanine green cholangiography, cystic duct remnant resection, and common bile duct exploration.

Intraoperative ultrasound confirmed a dilated cystic duct remnant communicating with the common bile duct and containing a large stone. After careful dissection of the hepatoduodenal ligament, the cystic duct remnant was opened and the stone extracted. The remnant was then divided flush with the common bile duct using a robotic vascular stapler to avoid ductal narrowing. Indocyanine green cholangiography confirmed biliary continuity and absence of bile leak.

A falciform ligament pedicle flap was used to buttress the transection site.

The patient recovered uneventfully and was discharged following an uncomplicated postoperative course.

This case illustrates the role of robotic hepatobiliary surgery in the management of complex post-cholecystectomy biliary pathology, particularly when endoscopic approaches are unsuccessful.