Daniel Gomez, MD, FACS1, Luis F Cabrera, General Surgeon2, Andres Mendoza, General Surgeon2, Ricardo Villarreal2, Mauricio Pedraza2, Jean Pulido2, Eric E Vinck2, Sebastian Sanchez2. 1CPO, 2Bosque University
Introduction: Laparoscopy has many known advantages, including shorter hospital stay and less risk of surgical site infection, however, when applied to Mirizzi Syndrome, due to the technical challenges, the degree of conversion to open surgery is very high , varying from 11.1% to 80%, as reported in the literature. Therefore, some experts recommend a laparoscopic approach only, for the management of Mirizzi Grade I Syndrome, due to the high risk of bile duct injury and the distortion of the anatomy.
Objectives: Show through a video presentation that the laparoscopic management of grade IV Mirizzi Syndrome is feasible in expert hands, with favorable results for the patient.
Materials: During a laparoscopic cholecystectomy we found a biliary fistula compromising more than a 66% of the common bile duct circumference, compatible with Mirizzi grade IV syndrome, then we proceeded with the resection of the fistula and subsequent reconstruction of the bile duct with a hepaticojejunostomy and Roux en Y, using a simplified technique similar to that described in the laparoscopic simplified gastric bypass by Cardoso and Galvao.
Results: Surgical time of 118.6 minutes, intraoperative bleeding of 15 cc, oral feeding and adequate tolerance POD 1, no reinterventions, no postoperative biliary leak, hospital stay of 5 days, and at 18 months follow up the patient remains asymptomatic.
Conclusions: The laparoscopic management of complex biliary tract disease demands the knowledge and expertise of surgical groups, trained in advanced laparoscopic techniques in order to be feasible and safe as demonstrated in this case.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94039
Program Number: V190
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop