Laparoscopic hepaticojejunostomy after bile duct injury
Adolfo Cuendis-Velázquez1, Carlos Morales-Chávez2, Itzé Aguirre-Olmedo3
1Division of General and Endoscopic Surgery, Hospital General Dr. Manuel GEA González, Calzada de Tlalpan 4800 Colonia Sección XVI Tlalpan, C.P. 14090, México City, D.F., Mexico. drcuendis@gmail.com.
Surgical Endoscopy
|June 21, 2015
Summary
Laparoscopic repair of bile duct injuries (BDI) is a safe and feasible approach for this complex surgical complication. This minimally invasive technique offers benefits even in severe BDI cases.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Minimally Invasive Surgery
Background:
- Bile duct injuries (BDI) occur in approximately 0.6% of cholecystectomies, posing significant medical and legal challenges.
- Laparoscopic repair of BDI represents an advanced surgical approach for managing these complex injuries.
Purpose of the Study:
- To present the initial experience of a center using a laparoscopic approach for bile duct injury repair.
- To evaluate the safety and feasibility of laparoscopic hepaticojejunostomy (LHJ) for managing post-cholecystectomy BDI.
Main Methods:
- A prospective study included 29 patients with BDI secondary to cholecystectomy between June 2012 and September 2014.
- Injuries were classified using the Strasberg classification, and all repairs involved a side-to-side anastomosis with Roux-en-Y reconstruction.
- Laparoscopic hepaticojejunostomy (LHJ) details, including segment 4b/5 resection and neo-confluence for E4 injuries, were recorded.
Main Results:
- Twenty-nine patients underwent laparoscopic BDI repair, with 82.7% being female, median age 42 years.
- 62% of injuries were at or above the confluence; 93.1% received primary repair. Eight neo-confluences were performed for E4 injuries.
- Median operative time was 240 minutes, with 17.2% experiencing bile leaks and 6.8% requiring re-intervention. No mortality was observed.
Conclusions:
- Minimally invasive approaches, including laparoscopic repair, are feasible and safe for managing bile duct injuries.
- Laparoscopic hepaticojejunostomy (LHJ) demonstrates promising outcomes in complex post-cholecystectomy BDI cases.
