Russian Sklifosovsky Journal "Emergency Medical Care" | VOL. 11
Restoration of Bile Outflow in Case of Damage to Hepaticocholedochus and Failure of the Biliary Anastomosis After Laparoscopic Cholecystectomy
Publication Date Sep 9, 2022
The aspect of injuring bile ducts during laparoscopic cholecystectomy is still of current concern. Causes of this complication include insufficient experience of surgical team, poor knowledge of topographic anatomy of subhepatic space, particularly when perivesical inflammatory infiltrate presents, inadequate approach conversion and so on. Most of patients with bile duct injuries undergo repeated operation in the same surgical unit where cholecystectomy was performed. In many cases, this results in a shortening of the segment of the common hepatic duct, which is favorable for restoration. Subsequent reconstructive surgery is usually performed in the worse conditions with a high risk of complications such as failure of sutures, biliary fistula, anastomotic stricture, etc. Most specialists recommend to abstain from primary reconstruction of the biliary tree in hospitals with no proper experience in hepatobiliary surgery and to perform only the external drainage of subhepatic space with subsequent admission of patient to a specialized clinic. We report a case of a young woman who suffered an excision of hepaticocholedochus fragment during laparoscopic cholecystectomy. A primary reconstructive surgery (hepatico-hepaticoanastomosis) was performed in the same clinic and resulted in external fistula of the common hepatic duct. The subsequent operation (hepaticoejunostomy) was performed in a specialized department of the regional clinical hospital. The woman underwent right-sided hypochondrium laparotomy with debridement of postoper...
Laparoscopic Cholecystectomy Primary Reconstructive Surgery Failure Of Sutures Bile Duct Common Duct Hepatobiliary Surgery Anastomotic Stricture Worse Conditions Biliary Fistula Primary Reconstruction
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No potential conflict of interest was reported by the authors. The conception and design of the study, acquisition of data, analysis and interpretatio...Read More
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