Laparoscopic Repair of a Common Bile Duct Injury

In this video, we present a laparoscopic repair of an inadvertent common bile duct injury during laparoscopic cholecystectomy in a 16 year old female. This patient had chronic cholecystits. She was brought to the operating room for a laparoscopic cholecystectomy. During dissection, the common bile duct was mistaken for the cystic duct and was ligated. Upon further dissection of Calot’s triangle, it became evident that it was in fact the common bile duct that was transected. A laparoscopic cholangiogram confirmed that the common bile duct was transected.
At this time, the Kocher maneuver was preformed to begin a choledochoduodenostomy to repair this injury. Once the duodenum was properly exposed, the endoscopic spatula was used to make an enterotomy in the duodenum. The anastomosis was created between the common bile duct and the duodenum with 3-0 vicryl suture. At this point, the sutures were not tied, but the tails of the suture secured in place by an endo-clip. An 8 French feeding tube wasinserted within the lumen of the anastomosis to act as a stent.The sutureswere tied and the patency of the anastomosisinspected. It appearedthat there was a bile leak. An additional 3-0 vicryl suturewas placed in the suture line. A Jackson-Pratt drain was inserted in the gallbadder fossa.
The patient tolerated the procedure well and has not experienced any complications in the four month postoperative period.


Session: Video Channel

Program Number: V080

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