Hepaticojejunostomy in proximal bile duct injury by left hepatic duct approach for patients attended at Muhimbili National Hospital

Abstract

Abstract Background Laparoscopic cholecystectomy has become a gold standard treatment for symptomatic cholelithiasis and other related diseases done in most centers worldwide. It is associated with an increase in frequency of iatrogenic biliary injury with an incidence of 0.3–0.7%, resulting in a significant impact on quality of life, overall survival, and frequently medico-legal obligations. Early recognition of bile duct injury (BDI) is of supreme importance towards early treatment and good outcome. With an experienced hepatobiliary surgeon, hepaticojejunostomy by left hepatic duct approach is often challenging and considered impossible due to scarring and fibrosis but has a noble outcome for proximal common hepatic duct injury. Cases presentation We described two cases from northern Tanzania who had iatrogenic proximal bile duct injury following laparoscopic cholecystectomy. Hepaticojejunostomy by left hepatic duct was the approach used after difficult dissection at porta hepatis and partly the liver tissue to attain a significant length of the left hepatic duct for anastomosis done at least 3 months post-bile duct injury. No postoperative complication was observed, which includes biliary fistula, restenosis, peritonitis, and cholangitis. To date, no evidence of biliary stenosis or other biliary complication happened during follow-up for 1 year. Conclusion Early recognition of BDI is of supreme importance towards early treatment and good outcome. With an experienced hepatobiliary surgeon, hepaticojejunostomy by left hepatic duct approach has an honorable outcome for proximal bile duct injury.

Keywords

• Bile duct injury
• Laparoscopic cholecystectomy
• Hepaticojejunostomy
• Left hepatic duct