RECONSTRUCTIVE SURGERY AT DAMAGED BILE DUCT AFTER LAPAROSCOPIC CHOLECYSTECTOMY

The aim of the investigations was justificating the method of reconstructive surgery in biliary injury during laparoscopic cholecystectomy.

Materials and methods. There were performed 986 laparoscopic cholecystectomy (LC) for acute and chronic calculous cholecystitis with postoperative mortality of 0.1%. Traumatic injury to the extrahepatic bile duct was at LC in 4 (0.4%) patients (1 man and 3 women). In 3 patients, the damage was detected intraoperatively and performed the conversion, and in one patient with an increase in jaundice reintervention was performed in three days.

Results and discussion. Damage to the common bile duct — 1, hepaticocholedochus — 2, the right and left hepatic duct — 1. Mechanical failure in 3 patients and electric burn of 2/3 perimeter of hepaticocholedochus — 1. The principle of reconstructive intervention is to perform hepaticojejunoanastomosis (3) and bihepaticojejunoanastomosis (1) by Roux with transjejunal external control drainage of hepaticocholedochus, and in one case we performed the double transjejunal external control drainage of the right and left hepatic ducts. Managed drains were removed in 1.5–2 months after surgery. There were lethal cases. Long-term results after 5 years: 3 patients — good, and one — chronic recurrent cholangitis under the control of integrated course of conservative therapy.

Conclusion. The method of choice of reconstructive intervention in damaged bile duct after LC is hepaticojejunoanastomosis by Roux with transjejunal external control drainage of proximal bile ducts.