Mix Laparoscopic and Endoscopic Bile Duct Repair

Abstract

Common bile duct injuries are serious and challenging surgical complications. These Complex injuries are most often a consequence of laparoscopic cholecystectomy. Most of the time, proper management requires a skilled and experienced hepatobiliary surgical team. We develop a mixed technique for a bile duct injury, type E2 Strasberg classification. First, we have to study the patient with ERCP, MRCP. Most of the time we receive patients with this type of injury from other hospitals. After determining the type of injury and the possibility of performing this technique, we perform an ERCP, installing a guidewire in the proximal bile duct end. Then we perform laparoscopic surgery, finding the distal end of the bile duct and progressing the guidewire previously installed, from the proximal to the distal end of the bile duct. Then we put a biliary stent through ERCP, in the bile duct and approximate the bile duct with 5-0 absorbable suture. Finally, we install a drain in the subhepatic space; remove the trocars, and finish the surgery. We obtain good results using this novel technique, which we think is feasible to perform and brings our patients the opportunity to access more easily to the bile ducts if there is any complication.