Daniel Gomez, MD, FACS1, Luis F Cabrera, General Surgeon2, Andrez Mendoza, General Surgeon2, Ricardo Villareal2, Mauricio Pedraza2, Jean Pulido2, Eric Vinck2, Sebastian Sanchez2. 1CPO, 2Bosque University
Introduction: The laparoscopic biliary tract exploration it's a challenging procedure by itself, but in patients with a hostile abdomen due to multiple adhesions secondary to previous surgeries, increase the risk of injuring the neighboring organs, and difficult the exposure of the operative field avoiding the critical identification of bile duct structures, making this an even more complex case scenario.
Objectives: To show that laparoscopic bile duct exploration plus the resection of a biliary fistula in patients with previous surgeries is feasible in expert hands, with favorable results for the patient.
Materials: This is a case of a patient with multiple previous open abdominal surgeries which presented with chodocholitiasis that couldn´t be resolve by ERCP, deciding to carried a laparoscopic three ports approach, beginning with a Palmer port on the right flank, performing a wide release of postoperative adhesions till achieving a better surgical field placing 2 additional working ports, proceeding with the dissection and resection of a duodenal gallbladder fistula using a linear stapler and subsequently to a laparoscopic biliary tract exploration with multiple giant stones extraction, primary closure of the CBD plus cholecystectomy.
Results: Surgical time of 155 minutes, intraoperative bleeding of 15 cc, oral intake at POD 1, no re-interventions, no postoperative biliary leak, no need for intensive care unit, no mortality and a 5-day hospital stay.
Conclusions: The most complex step in the exploration of the laparoscopic bile duct in patients with previous abdominal surgery is the creation of the pneumoperitoneum and the extensive release of adhesions, in order to obtain an adequate operative field, in addition to a primary closure of the common bile duct, which has shown to have fewer complications and costs when compared to the T-tube, since the laparoscopic approach in this special type of patients has not been shown to increase bleeding or perioperative complications in expert hands.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95299
Program Number: V311
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop