Excluded-Loop Hepatojejunal Anastomosis With Use of Laparoscopy in Late Management of Iatrogenic Ligature of the Bile Duct

Abstract

Although the procedures adopted for bile duct surgery are routine, serious complications occasionally occur. This article reports the authors' experience in managing an iatrogenic ligature of the bile duct. The patient in this case had undergone open cholecystectomy and had significant jaundice in the early postoperative period. During the investigation, a complete ligature of the common hepatic duct was discovered. An anastomosis of the common hepatic duct with an excluded jejunum loop was performed with use of laparoscopy. Periodic follow-up continuing until 30 months after surgery showed the patient was asymptomatic, and ultrasonography, percutaneous transhepatic cholangiography, and cholangioresonance findings were normal. We consider the procedure feasible and technically advantageous when done with the assistance of laparoscopy.

Proposal of a new technique for bile duct reconstruction after iatrogenic injury: study in dogs and review of the literature

“…Since in most cases the borders of the bile duct are separated or the distal portion cannot be identified, bile duct reconstruction is more frequently performed by choledochoduodenal or choledochojejunal Roux-en-Y diversion 20 . At present, good results have been reported for laparoscopic Roux-en-Y biliary-digestive anastomosis 19,21 . Although being the best therapeutic option for the treatment of proximal bile duct injuries, the disadvantage of a biliary-digestive anastomosis using an excluded jejunal loop is the deviation of bile from the duodenum and proximal jejunum.…”

“…In these cases, endoscopic retrograde cholangiopancreatography is performed in combination with papillotomy and placement of a nasobiliary catheter or biliary prosthesis 7,12,13 . Extensive lateral lesions, complete sectioning or ligation of the bile duct and long strictures require laparoscopic or laparotomic surgical treatment 14,15,16,17,18,19 . When the loss of bile substance is small, endto-end reconstruction can be performed as long as the suture can be placed without tension.…”

Estudo ultrassonográfico morfométrico do fígado e trato biliar de suínos submetidos a obstrução biliar experimental

“…The option for the videolaparoscopic surgery was justified for being the most utilized technique to approach biliary ducts, besides other advantages such as better acceptance by patients, smaller incisions, better aesthetic results, less postoperative pain, besides shorter hospital stay and low incidence of complications (2,19,24) . In such a context, a more efficient surgical recovery of the animals was observed, since manipulating the animals for wound dressing is more practical and agile and the surgical wound healing is faster with less stress for the animals.…”

“…Bile duct injuries usually affect the upper part of the duct located close to the hepatic hilum, making it difficult to perform appropriate choledochoduodenal reconstruction (19) . Additionally, injuries requiring biliary repair are commonly associated with long term complications, and the level of the injury and timing of repair are associated with the risk for post-surgical stenosis (20) .…”

Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives

“…The feasibility of laparoscopic repair of postcholecystectomy biliary stricture was first reported in 2002 by Crema et al [ 14 ]. Despite the encouraging results, the laparoscopic approach was not widely used, and publications were limited only to case reports.…”