Bile Duct Injury, Strasberg E3, Secondary to Open Cholecystectomy, Resolved by Minimal Invasion with Robotic Assistance. Multidisciplinary Management of Bile Duct Injuries

Abstract

We present the case of a 44-year-old male with a complex bile duct injury during an open cholecystectomy due to scheduled surgery, referred to our unit for definitive management. Material and methods A 44-year-old patient who was admitted to our unit referred from his health level, presenting with a noticeable disruption of the bile duct during open cholecystectomy, identified in the intraoperative period, and managed with cannulation of the hepatic duct with a feeding tube. On admission 7 days after the operation, referring to mild pain at the surgical wound site, with a feeding tube with frank biliary output of 400 cc daily. A study protocol is carried out for staging the lesion, reporting at the level of the contrasted computerized axial tomography, with a high lesion, of apparent presence at the immediate level of the confluence. Conditions of the patient are improved and their intervention is decided with a view to definitive derivation by means of minimal invasion assisted by robot. Which is performed 2 days after admission due to a patient with adequate evolution without an inflammatory response. Finding a cavity with no evidence of bile leakage, with the complete section at the level just below the confluence, with the cannulated hepatic duct, deciding to perform a Roux-en-Y hepatojejunum, with enlargement of the left hepatic duct, 0.5 cm , and the formation of the anastomosis with intracorporeal V-Lock, subsequent lavage of the cavity and placement of a drain.