Common Bile Duct Injury During Laparoscopic Cholecystectomy. From Disaster to Reconstruction.

Guido De Sena, MD, Francesco La Rocca, MD, Carlo Molino, MD, Francesco Chianese, MD, Antonio Braucci, MD, Rosaria De Ritiis, MD

Department Of General Surgery, Cardarelli Hospital – Naples, Italy

INTRODUCTION: The aim of the study is to describe and divulgate the surgical errors that must be avoided during laparoscopic cholecystectomy.

METHODS AND PROCEDURES: The movie shows a common bile duct (CBD) injury occurring during a laparoscopic cholecystectomy performed in another hospital and its repair in open surgery done in our deparment. A high-flow bile fistula (800-1000 ml/24hrs) characterized the immediate post-operative course. MRI cholangiography showed a complete lesion of the CBD. On fifth post-operatory day, the patient was transferred to our department. Subsequent diagnostic tests showed a double lesion of the CBD, at the level of the upper-pancreatic tract and at the biliary confluence. The repair consisted of a Roux-en-Y hepaticojejunostomy.

RESULTS: The post-operative course was uneventful and the patient was discharged on 14th day. MRI cholangiography performed before the demission showed a complete surgical recovery.

CONCLUSION: The authors show clearly and in detail the chilling path of surgical error and they underline the strategy for preoperative diagnosis and the surgical technique for biliary tract reconstruction. The surgeons perform this technique for over 20 years with excellent results, with no mortality and no long-term postoperative complications. They conclude highlighting the importance of viewing the original video of laparoscopic cholecystectomy to accurately evaluate the damage and decide preoperatively the strategy for biliary tract repair.

Session: Video ChannelDay 2

Program Number: V077

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