Laparoscopic Hepaticojejunostomy after Strasberg E4 Bile Duct Injury.

Adolfo Cuendis, MD, Carlos Morales, MD, Martin Rojano, MD. Hospital General Dr Manuel Gea Gonzalez.

22 year old female with a history of biliary pain during pregnancy (2months ago), which is subjected to laparoscopic cholecystectomy for cholecystitis, presenting comun bile duct injury during that procedure staged as a Strasberg E2 bile duct injury, a nelaton catheter is left in the conduct who thought to be the common duct.

Is sent to our hospital within 24 hours after surgery and we performed a cholangiogram through nelaton tube finding the opacification only a segment of the right intrahepatic biliary tree.

Surgery was made by laparoscopic approach, abundant free bile was find in abdominal cavity and nelaton tube directed to the right hepatic duct.
The left and right hepatic ducts where completely separated without confluence and rights segmentary conducts exposed.

A neo confluence and hepaticojejunostomy was performed.

Uncomplicated course allowed starts in the postoperative day two orally intake and discharged on the fourth day, removing the drain on the sixth day as outer patient.

The patient remained asymptomatic to date with normal liver functioning tests.

The laparoscopic approach by experienced surgeons, is safe and feasible even in cases of serious injury of bile duct.

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