Common Bile Duct Stricture After Laparoscopic Cholecystectomy: Case Report

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Abdominal Surgery Complications

Background:

• Laparoscopic cholecystectomy, while advanced, still presents a significant risk of bile duct injury (BDI), with incidence rates of 0.3%-0.6%.
• Bile duct injuries are severe complications that can necessitate liver transplantation.
• Identifying and managing these injuries requires a comprehensive diagnostic and surgical strategy.

Observation:

• A 78-year-old male patient presented with jaundice eight months post-laparoscopic cholecystectomy due to a common hepatic duct injury.
• Diagnostic imaging (ERCP and MRCP) revealed a metal clip causing bile duct stricture and proximal dilatation (Strasberg type E3 injury).

Findings:

• Surgical repair involved a termino-lateral hepaticojejunostomy connecting hepatic ducts to a Roux-en-Y jejunal limb.
• The case highlights the critical need for intraoperative cholangiography when Calot's triangle anatomy is unclear.

Implications:

• Emphasizes the importance of timely conversion to open surgery and intraoperative cholangiography to prevent bile duct injuries.
• Successful management of bile duct injuries relies on a collaborative approach involving radiologists, gastroenterologists, and experienced hepatobiliary surgeons.