Salvage treatment of laparoscopic cholecystectomy‐associated bile duct stenosis combining laparoscopic and endoscopic procedures: A case report

Abstract

The incidence of laparoscopic cholecystectomy (LC)-associated bile duct injury has reached a steady state despite learning curve effect. Herein we report the case of a 74-year-old Japanese man who suffered from bile duct stenosis and stones after LC. The stenosis was due to stricture caused by surgical clips used inappropriately during LC. We planned a salvage treatment combining laparoscopic and endoscopic approaches. At laparoscopic observation, the clips had already invaded the right side of the bile duct; minimal absorbable suture was performed after all the clips were removed. The bile duct stenosis was then endoscopically dilated and the biliary stones were successfully removed. For the recurrent biliary stenosis after discharge, endoscopic balloon dilation was performed and multiple plastic stent tubes were placed. The stent tubes were removed 4 months later, and the patient has had no symptoms for 1 year. A combined laparoscopic and endoscopic approach was useful for the salvage treatment of LC-associated bile duct stenosis.

Lesión quirúrgica del conducto hepático derecho: tratamiento combinado laparoscópico-endoscópico

“…En reportes anteriores, hemos ilustrado la técnica combinada láparo-endoscópica para el manejo de la patología biliar benigna, específicamente para el tratamiento de la litiasis (11,12) y sus beneficios han sido demostrados en meta análisis recientes (13) . La factibilidad de este abordaje, para el tratamiento de la LQVB, ha sido descrito previamente (14) y recomendado dentro de la primera semana de generada la lesión (4) . La exploración laparoscópica, a pesar de sus múltiples ventajas, posee el riesgo potencial de lesiones viscerales, lo cual aumenta en relación al número de intervenciones quirúrgicas previas (15) , incrementando la complejidad del procedimiento y sus exigencias técnicas.…”