Original method for restoring the continuity of the lobar duct of the liver in case of iatrogenic damage

The OBJECTIVE was to demonstrate an original minimally invasive way to restore the continuity of the lobar duct after its complete intersection.

METHODS AND MATERIALS. The study included 3 patients aged 38, 56 and 69 years who underwent laparoscopic cholecystectomy for cholelithiasis, cholecystolithiasis in various medical institutions of the city. In all patients, the intersection of the right lobar duct with the formation of an external biliary fistula in the postoperative period was revealed. RESULTS. All patients underwent recanalization of the crossed duct on the first attempt. After the fistula was formed on the frame drainage, the flow of bile through the external biliary fistula gradually regressed: in one patient, bile leakage from the abdominal cavity stopped after two days, in two patients after a week. Drainages from the subhepatic space were removed in all patients on the 9th day after restoration of the continuity of the intersect duct. Kehr's drainage was removed after 12 days in one patient, after 21 days in another. Retrograde external drainage was removed from the third patient on the 5th day after restoration of the patency of the duct on the frame drainage. After control X-ray images, the external-internal frame drainages were blocked for patients on the 5-10th day after the operation. There were no leaks of contrast agent through the restored section of the duct.

CONCLUSION. The developed method of minimally invasive restoration of continuity and patency of the intersected and excised hepatic duct is an alternative to the traditional reconstructive biliodigestive bypass surgery. Long-term frame drainage of the bile duct in the area of damage allows forming sufficient diameter for an unobstructed passage of bile.

1. Fingerhut A., Dziri C., Garden O.J. et al. ATOM, The All-Inclusive, Nominal EAES Classification of Bile Duct Injuries During Cholecystectomy // Surg Endosc. 2013;27(12):1-12. Doi: 10.1007/s00464-013-3081-6.

2. Gupta V., Jayaraman S. Role for Laparoscopy in The Management of Bile Duct Injuries // J Can Chir. 2017;60(5):300-304. Doi: 10.1503/cjs.003317.

3. Schreuder A. M., Busch O. R., Besselink M. G. et al. Long-Term Impact of Iatrogenic Bile Duct Injury // Dig Surg. 2020;37(1):10-21. Doi: 10.1159/000496432.

4. Thompson C. M., Saad N. E., Quazi R. R. et al. Management of Iatrogenic Bile Duct Injuries: Role of the Interventional Radiologist // RadioGraphics. 2013;(33):117-134. Doi: 10.1148/rg.331125044.

5. Ivanov S. V., Golikov A. V., Tarabrin D. V., Klimkin A. S. Tactics for the treatment of iatrogenic injuries and strictures of the extrahepatic biliary tract // Medical Review. 2018;(120):16-18. (In Russ.).

6. Abdulaev A. A., Abdulaev B. A. Surgical tactics in iatrogenic injuries of the extrahepatic biliary tract // Bulletin of the Russian Military Medical Academy. 2019;65(1):15-18. (In Russ.).

7. Kolesnikov S. A., Pakhlevanyan V. G., Kopylov A. A. Surgical tactics for injuries of extrahepatic and main intrahepatic bile ducts as a result of minimally invasive cholecystectomy // Scientific Vedomosti. Series Medicine. Pharmacy. 2015;30(10):39-43. (In Russ.).

8. Galperin E. I., Chevorkin A. Y. «Fresh» injuries of the bile ducts // Surgery. Journal them. N.I. Pirogov. 2010;10(4):4-10. (In Russ.).

9. Lubikowski J., Piotuch B., Stadnik A. et al. Difficult Iatrogenic Bile Duct Injuries Defferent Types of Upper Abdominal Surgery: Report of Three Cases and Review of Literature // BMC Surg. 2019;162(19):1-9. Doi: 10.1186/s12893-019-0619-0.