Management of Trans-Section of Right Hepatic Duct during Laparoscopic Cholecystectomy and Primary End to End Anastomosis-A Case Report

Abstract

Laparoscopic cholecystectomy is standard treatment for cholelithiasis. It associates with high incidents of complications when compared to open cholecystectomy. Most common complication is bile duct injuries associate with high morbidity. Normally, proximal ductal injuries are repaired by hepatico-jejunostomy since the incidence of stricture is more common with end-to-end anastomosis. We came across one such case of right hepatic duct injury where the right hepatic duct was completely transected. Immediate end-to-end primary anastomosis was done on a 5F feeding tube. Post-operativecholangiogram (CGM) showed minimal leak at the anastomotic site, displaying the normal proximal ductal system of right lobe. Patient was normal after following for 18 months. It is our opinion that primary anastomosis is preferable particularly when duct is larger in caliber as in our case it was admitting 5F feeding tube. Primary end-to-end anastomosis will reduce the morbidity form leak since chances of leak are more hepatico-jejunostomy and prevent possible ascending cholangitis.