• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Two-stage laparoscopic approach for a bile duct injury with a two-week biliary peritonitis

Marcel Sanhueza, MD1, Rose Marie Mege, MD1, Eduardo Vinuela, MD1, Eduardo Briceno, MD1, Cristian Diaz, MD1, Constanza Godoy1, Gustavo Carvalho, MD, PhD2, Julian Varas, MD3, Nicolas Jarufe3, Alfonso Diaz, MD1. 1Complejo Asistencial Dr. Sotero del Rio de Chile, 2Faculty of Medical Sciences, University of Pernambuco, Recife, Brazil, 3Department of digestive surgery, Pontificia Universidad Catolica de Chile

The Objective of this video is to present how a complex case of a Bismuth-Strasberg E2 biliary injury with an associated biliperitoneum was resolved with a pure laparoscopic two-stage approach starting at postoperative day 10. The surgical team involved in this case has over 10 years of advanced HBP laparoscopic experience.

Case: A 56-year-old female to whom a laparoscopic converted to open cholecystectomy for acute cholecystitis was performed. The patient was discharged at postoperative day 3 uneventfully. Ten days after surgery the patient was readmitted for abdominal pain, nausea, jaundice and having signs of peritoneal irritation on physical examination. Abdominal ultrasound indicated pelvic free fluid, suprahepatic collections and a dilated intrahepatic biliary tract raising the suspicion of a major bile duct injury with associated biliary peritonitis.

Stage 1, Exploration and Lavage:

In order to avoid adding with a large laparotomy a huge inflammatory response to the already established septic process, a laparoscopic exploration and lavage was performed. After a successful open umbilical pneumoperitoneum, a first inspection revealed an extensive biliary peritonitis with severe adhesions and subphrenic collections. Once careful adhesiolysis using blunt dissection was performed, a bile leak from the main biliary tract was observed and a drain was left in place next to it, in addition to two other drains left in both subphrenic spaces.

The bile leak drain conducted the hepatic clearance for three weeks till it stopped and the patient progressively accumulated serum bilirubin.

From this point on, and given the favorable evolution of the patient, the surgical team decided to complete a six weeks period after stage one intervention in order to favor a better surgical outcome for a second laparoscopic exploration.

Stage 2, Reconstruction:

An open pneumoperitoneum was again made this time trough the right flank to avoid possible adhered bowel to the abdominal wall as suggested by CT-scan controls. The exploration showed no evidence of residual collections and most adhesions found were loose. Using blunt dissection all these adhesions were freed until the hepatic pedicle was clearly identified. A special effort was made to release the stomach and duodenum from the pedicle in order to have a clear view of the portal vein bifurcation and the understanding of the altered anatomy of the biliary tract. The common bile duct was ligated and completely transected at 1 cm from the confluence.

Preparation of Roux-en- Y anastomosis with a short transmesocolic biliary limb was created. The biliary confluence for an end-to-side hepaticojejunostomy was accessed by sectioning and removing the scar tissue on the proximal common bile duct stump. After the bile-diversion was performed all gap spaces were closed.

Postoperative course was uneventful and the patient discharged at the fourth day.

Conclusion: A two-stage approach in order to face with a two-week biliary peritonitis secondary to a iatrogenic bile duct injury is feasible an may favor the evolution to a less dramatic solution for this complex scenario.

86

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons