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Cirugía y cirujanos
versão On-line ISSN 2444-054Xversão impressa ISSN 0009-7411
Resumo
GOMEZ, Daniel et al. Laparoscopic Roux-en-Y hepaticojejunostomy reconstruction after iatrogenic bile duct injury: case series report. Cir. cir. [online]. 2020, vol.88, n.5, pp.608-616. Epub 08-Nov-2021. ISSN 2444-054X. https://doi.org/10.24875/ciru.20001541.
Introduction:
Bile duct injury (BDI) is a devastating complication after a cholecystectomy. Laparoscopic management has become a mainstay approach because of the advantages offered to patients; nevertheless, outcomes after repair are influenced by the center, the surgeon's experience, and the type of reconstruction.
Materials and methods:
Patients with common BDI managed at a referral center from January 2013 to June 2018 with a novel modified and simplified laparoscopic technique for a hepatic duct jejunostomy with a Roux-en-Y reconstruction were retrospectively reviewed.
Results:
Twenty patients had a BDI (20/5430-0.3%), 8 (40%) had intraoperative diagnosis, and 12 (60%) patients with diagnosis before 72 h. Type E Strasberg classification, the predominant BDI was Strasberg E1 (65%), the average surgery time was 146.5 min (115-178 min), the average intraoperative bleeding was 15-50 cc. The overall complication rate was 10 % (2/20), 1 (5%) patient required, there were no mortalities, and the mean hospital stay was 5 days. One (5%) patient presented bile leak (Type SE4), and 1 (5%) patient required intensive care unit admission after reintervention. Long-term follow-up showed no bile duct stricture, cholangitis, or recurrent choledocholithiasis up to 5 years after the procedure and with a minimum of 1 year minimum follow-up.
Conclusions:
This simplified laparoscopic approach to bile duct reconstruction with Roux-en-Y anastomoses appears to be an effective and safe alternative to reconstructive open bile duct surgery, offering to patients the benefits of laparoscopic surgery with a low complication rate.
Palavras-chave : Laparoscopic approach; Bile duct injury; Reconstruction; Bile leakage.