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Right hemihepatectomy for bile duct injury following laparoscopic cholecystectomy
S Heinrich1, H Seifert, L Krähenbühl
1Department of General and Vascular Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. stefan.heinrich.chi.usz.ch.
Insights
Laparoscopic cholecystectomy (LC) can lead to bile duct injuries. Prompt diagnosis with ultrasound and endoscopic retrograde cholangiography (ERC) is crucial for effective management, often avoiding emergency surgery.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholecystolithiasis.
- Increased incidence of bile duct injuries (BDI) is a known complication of LC.
- Timely and accurate diagnosis of BDI is critical for patient outcomes.
Observation:
- A 33-year-old male presented with BDI two weeks post-LC.
- Initial management included laparotomy and T-tube insertion.
- Endoscopic retrograde cholangiography (ERC) revealed an extensive right biliary defect unsuitable for endoscopic repair.
Findings:
- Emergency laparotomy was required for portal vein bleeding.
- Massive inflammation and bile duct destruction necessitated liver resection.
- The patient experienced a prolonged but ultimately successful recovery after complex surgical interventions.
Implications:
- Ultrasound and ERC are essential for diagnosing and classifying BDI.
- Emergency laparotomy should be avoided without prior diagnostic imaging and classification.
- Specialized hepatobiliary centers are recommended for managing complex BDI cases.
Abstract:
Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic cholecystolithiasis. But with the introduction of this technique, the incidence of bile duct injuries has increased. We report the case of a 33-year-old man who was transferred from an affiliated hospital to our department for the treatment of a bile duct injury 2 weeks after LC. Prior to transfer, a laparotomy had been performed, with insertion of a T-tube and a Robinson drain on day 5 after LC. Endoscopic retrograde cholangiography (ERC) on admission day revealed an extensive defect of the right biliary system, which could not be treated endoscopically. An emergency laparotomy had to be performed at night for acute bleeding from the portal vein. Due to massive inflammation in the porta hepatis and intraparenchymal destruction of the right bile duct, liver resection was performed 2 days later, after the patient had stabilized in the intensive care unit (ICU). The patient had a prolonged postoperative course, but he finally recovered well from these operations. In conclusion, the management of bile duct injuries should include ultrasound to detect and drain fluid collections and ERC to classify the injury. Emergency laparotomy should never be performed without these examinations, since the majority of bile duct injuries can be treated endoscopically. Surgery for this serious complication should always be performed at specialized centers for hepatobiliary surgery.