Roux-en-Y hepaticojejunostomy is the procedure of choice in the management of patients with major bile duct injuries. In instances of anastomotic stricture, this anastomosis is inaccessible to conventional endoscopy. A technique is described for assessment and intervention of bilioenteric anastomoses that escape the reach of conventional endoscopy. Three cases are presented illustrating the feasibility of open and laparoscopic-assisted small-bowel endoscopy. All patients presented with recurrent cholangitis and had multiple interventions in their biliary tree prior to referral. At operation, the limb of jejunum going to the bilioenteric anastomosis was identified, an enterotomy was made, and a flexible endoscope was passed to evaluate the anastomosis. In two cases the anastomosis was revised by endoscopically excising scar tissue. In the third case the anastomosis was patent and unnecessary intervention was avoided. There was no morbidity or mortality and the patients had complete resolution of their symptoms. Operative endoscopy appears to be useful in the evaluation and intervention of bilioenteric anastomoses that cannot be evaluated by conventional endoscopy.
Iatrogenic vascular injuries of the hepatic artery are infrequent and a serious complication of LC. There is no doubt about the many advantages of LC when compared to open cholecystectomy. Despite this, there is an increase in the reported incidence (0.3%-1.0%) of biliary and vascular injuries. Most arterial complications are due to direct injury or diathermy shortening on surgical clips and HAP is one of them. We present a case of a 39-year old male patient who presented with this complication and how it was resolved.
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