Intra and extraglissonian approach with partial resection of IV-V segments for intrahepatic bile duct injuries

Abstract

Background: Laparoscopic bile duct injuries (LBDI) are more often intrahepatic, with associated vascular injury and disappearance of the bile duct segments than in open surgery. Their repair is a difficult challenge for the surgeon. Methods: Between January 1991 and March 2016, 11 patients with LBDI (E4) were satisfactorily resolved by an extra and intraglissonian approach developed by our unit. We performed a combined intraglissonian and extraglissonian approach resecting the base of the IVb and V segment, in search of the intrahepatic bile radicals to the uninjured zone. We performed and intrahepatic HY-Roux in all cases and due to the low caliber of intrahepatic bile radicals we left transanastomotic tutors (between 2 and 5), which were maintained between 3 and 6 months after surgery. In 4 cases they had RHA injury. Nine patients were treated at their hospital with HY-Roux. Four patients were diagnosed of secondary biliary cirrhosis candidate to liver transplant. Three patients had acute diffuse peritonitis requiring urgent surgery. Results: There was no mortality. One patient had a biliary leakage treated with percutaneous radiological drainage. Surgical time was 270 min (range 200–480 min). Patients are asymptomatic with a median follow up of 6 years (range: 10 months–19 years). Conclusion: Our technique in severe intrahepatic lesions associated with vascular lesions obtained satisfactory results.