Machado MA,Surjan R, Makdissi F

Journal of Visceral Surgery Epub

Laparoscopic right hepatectomy for complex biliary injury after laparoscopic cholecystectomy

Post-cholecystectomy bile duct injury remains a major concern as its incidence is steady along the years, despite technical advances. A complex biliary and arterial lesion after laparoscopic cholecystectomy may require liver resection. In some circumstances major liver resection is necessary and can be the definitive treatment. In a worldwide review, 99 hepatectomies were reported among 1756 (5.6%) patients referred for post-cholecystectomy bile duct injury. None of them was performed by laparoscopy. The aim of this video is to present a laparoscopic right hepatectomy in a patient with complex biliary injury.Therefore, intrahepatic approach to the right Glissonian pedicle was used and an anatomic right hepatectomy was performed. Operative time was 220 minutes. Blood loss was 400 mL and there was no need for transfusion. Recovery was uneventful, and she was discharged on the 4th postoperative day. Drain was removed on the 7th postoperative day. Liver enzymes normalized after surgery. Left liver presented satisfactory hypertrophy. She is well and asymptomatic 15 months after operation. In Conclusion, laparoscopic right hepatectomy is feasible in selected patients with complex bile duct injury. Intrahepatic Glissonian approach is a good option in patients with previous manipulation of the hepatic hilum but previous experience with this approach is warranted.