Pablo Achurra1, Erwin Buckel1, Eduardo Viñuela2, Julian Varas1, Rose Marie Mege2, Alfonso Diaz2, Nicolas Jarufe1, Sanhueza Marcel1. 1Department of Gastrointestinal Surgery, Pontificia Universidad Católica de Chile, 2Hospital Sotero del Río, Santiago, Chile
Background: Mirizzi Syndrome is a rare complication of gallbladder stones that results in compression, stenosis and often inflammatory destruction of the common bile duct. The laparoscopic approach is controversial due to the high technical difficulty and high conversion rates.
The aim of this video is to present a case of Mirizzi syndrome with destruction of the biliary confluence and intrahepatic stones that underwent a laparoscopic resection and posterior hepatico-jejunal anastomosis. The video also demonstrates the importance of intraoperative ultrasonography and choledocoscopy for the management of this patients.
Video Description: The video starts with the presentation of the clinical case and the preoperative MRCP. The image demonstrates a stricture of the biliary confluence with dilatation of the interlobar ducts and intrahepatic stones.
A laparoscopic exploration was performed, the hepatic hilium was dissected and the distal CBD exposed and transected. The dissection continues cephalad identifying the biliary confluence stricture, the hepatic artery and the portal vein. The interlobar bile ducts were transected proximal to the stricture and 4 ducts were identified.
Laparoscopic ultrasonography identified the location of the intrahepatic stones and they were extracted using a 5mm Choledoscope.
A roux en Y limb was created and then the hepatico-jejunostomy was performed with two running sutures including the four ducts in one wide anastomosis. There was no bile leak at the end of the procedure.
The patient was discharged home on postoperative day 5. Ultrasonography was normal at 3 months of the procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80764
Program Number: V157
Presentation Session: Plenary 2
Presentation Type: Video