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Laparoscopic reconstruction of extrahepatic bile ducts

Khatkov I.E., Izrailov R.E., Krivonosov K.V., Atroshenko A.O., Tyutyunnik P.S.

AIM: to show the possibility of laparoscopic approach to reconstruction of common hepatic duct after transecting and “open” surgical procedure.

PATIENTS AND METHODS. A 39 years old woman underwent laparoscopic cholecystectomy in case of acute cholecystitis with intraoperative complication – full transection of common hepatic bile duct right below the confluence. The operation was finished with external drainage of the external bile ducts by “open” approach. These tubes fell-out early after operation and the patient entered to our hospital, where percutaneous transhepatic drainage was installed. Four months later the patient came to the hospital for reconstruction procedure. After full preoperative examinations the reconstruction of the extra hepatic bile duct was performed using totally laparoscopic approach through five 10 and 5 mm trocars. Hepaticojejunostomy, using Roux-en-Y loop, was performed with the help of Harmonic and linear stapler for mobilization and transecting of the jejunum. The anastomosis was performed by intracorporal one-row continuous monofilament suturing.

RESULTS: the operative time was 240 min, the blood loss was 30 ml. The patient had bowel movements and was active from the second postoperative day. There were no any complications. Postoperative hospital stay was 10 days. The patient was discharged without drainages.

CONCLUSION: the laparoscopic approach is safe and effective method or reconstructive extrahepatic bile ducts surgery. It is very precise and may be used in some cases by experienced surgeons.

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