[Complete section of the main bile duct during laparoscopic cholecystectomy. Surgical treatment]. / Sezione completa della via biliare principale durante colecistectomia laparoscopica. Trattamento chirurgico.

ABSTRACT

Three cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. They were executed in other hospitals and presented big technical restoring difficulties, not easily resolvable. In 2 cases of lithiasic cholecystitis there was a complete damage of common biliary duct, in the third one there was a double main biliary duct binding with removal of a biliary tract segment. In all cases a biliary confluence-jejunal anastomosis with Roux en y loop was made up. In all cases the operation was difficult because of main bile duct fragility and modest expansion. In the third one the presence of a secondary biliary duct in gallbladder fossa not recognized but drained outside with a common drainage placed during the operation has prevented appearance of jaundice with dilatation of biliary ducts. It has heavily conditioned confluence-jejunal anastomosis with Roux en Y loop. In all cases tubes were left in the biliary duct for few months in order to calibrate it. In 2 patients postoperative course was characterized by the appearance of an external biliary fistula which has spontaneously disappeared. One year later both patients don't present any stenosis or cholangitis problem.