Creation of Neo-Bile Duct in Patients with Hepatic Duct Injury or Transection during Laparoscopic/Robotic Cholecystectomy

Abstract

Introduction: Iatrogenic injury of the bile duct or hepatic ducts during surgery can have severe consequences, sometimes requiring liver transplantation or hepaticojejunostomy. The incidence of Bile Duct Injury (BDI) occurs at 0.3%-0.7%, resulting in a significant impact on quality of life [1]. The incidence of BDI has increased as LC has become the "gold standard" for the treatment of symptomatic cholelithiasis [1]. Surgical repair of BDI is associated with significant morbidity and symptoms typically present as Right Upper Quadrant (RUQ) pain, jaundice, elevated liver function testing, fever, and leukocytosis [2]. Clipping of the bile duct can lead to complete obstruction at varying levels, including L & RHD clipping and transection. BDI rates vary depending on factors mortality, including: anastomotic leak, abdominal abscess, and liver failure [3]. Mortality rates depend on the type of injury, and comorbidity can range from 20-40% [3]. Case Presentation:We present a patient with iatrogenic bile duct and hepatic duct injury who underwent successful neo-bile duct creation eliminating the need for liver transplantation or hepaticojejunostomy. Conclusion: Placement of transhepatic internal and external stents using a rendezvous approach helps create a neo-bile duct and can prevent the need for major surgery.