Double gallbladder—intraoperative finding at laparoscopic cholecystectomy: Literature review

Duplication of the gallbladder is a rare entity. It is often appreciated at surgery and has a higher propensity for complications and conversion to open surgery. We report a case of laparoscopic recognition and removal of a duplicated gallbladder opening into the bile duct through separate cystic ducts, in a young male presenting with biliary colics. Both cystic ducts were clipped and divided, and cholecystectomy completed laparoscopically. Although uncommon, awareness of this anomaly may contribute to minimising iatrogenic bile duct injuries.

Simultaneous Early Surgical Repair of Post-Cholecystectomy Major Bile Duct Injury and Complex Abdominal Evisceration: A Case Report

Background: Major bile duct injuries (BDIs) are hazardous complications after laparoscopic cholecystectomy (0.4%-0.6% of all laparoscopic cholecystectomies) [1, 2-4]. Major BDIs usually require surgery, ideally either within one week or after 3 three months after index surgery [1]. We describe the case of iatrogenic transection of the common bile duct (CBD) complicated by a complex full midline abdominal evisceration presented on day 12 after emergency laparotomy for biliary peritonitis. Case Presentation: A 65-year-old male underwent laparoscopic cholecystectomy in a district general hospital and was discharged on the same day, following apparently uneventful surgery. He, however, re-presented two days later with biliary peritonitis when emergency ERCP showed full CBD transection. The local surgical team performed midline exploratory laparotomy, washout, and external drainage aside the leaking CBD and referred the case to our tertiary HPB service. While awaiting transfer (due to bed shortage), full wound dehiscence occurred. On transfer arrival at our HPB service on postoperative day 11, the patient presented extensive evisceration with loss of domain and persisting high-volume biliary spillage aside bowels. Following assessment and fast literature review, we considered operation undeferrable and planned multi-stage surgeries, including primary Roux-en-Y hepaticojejunostomy (HJ) and progressive abdominal wall closure in multiple sessions under general anaesthesia, aided by vacuum-assisted wound closure and intraperitoneally mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. Discussion and Conclusion: The complexity of our case lies in the coexistence of 2-weeks biliary peritonitis following early BDI with massive midline evisceration, in combination, both representing over 40% mortality risk, requiring immediate, simultaneous repair. Roux-en-Y HJ and VAWCM have proven safe and effective.

EP.TH.316Laparoscopic Cholecystectomy in KGH in 2019 - Comparing the Incidence of Complications and Patient Demographics to National Data

Aims Bile Duct injury is one of the serious complications of Laparoscopic Cholecystectomy and should be avoided. Several recent large studies that have examined Bile Duct Injuries (BDI) during cholecystectomy have found major BDI rates of 0.15-0.36% and an overall biliary complication rate of 1.5% if bile leaks are included. We wished to identify our current complication rate and compare to national data. Methods Retrospective study Data time frame from: 01/01/2019 to 31/10/2019 Type of patients: All patients who underwent elective or emergency laparoscopic cholecystectomy between the above dates Results 312 patients identified and analyzed over the study period. 227 female (72.76%) and 85 male (27.24%) 268 Elective operations (85.9%). 44 Emergency operations (14.10%) Primary outcome Secondary outcomes Conclusions KGH performed 312 cholecystectomy operations between Jan - Oct 2019, putting it in the upper 1/3 of hospitals regarding the number of operations performed per year. (1) The complication rate for the study period was 0.32%. This was one out of the 312 operations. Our incidence of complications is lower than published data reporting complication rates, including bile leaks, of up to 1.5%. There were no bile duct injuries during the study period. The majority (>85%) of cases were performed as elective operations.

Laparoscopic choledochoduodenal anastomosis after bile duct injury in a patient with previous laparoscopic gastric bypass

Bile duct injuries after laparoscopic cholecystectomy remain a major problem in gastrointestinal surgery. Twenty five to thirty percent of bariatric patients could develop gallstone disease. However, laparoscopic cholecystectomy in this group may result challenging due to the presence of a previous Roux-en-Y reconstruction. We documented the successful case of 66 year old female with story of non-supplemented laparoscopic gastric bypass, with subsequent injury of bile duct during laparoscopic cholecystectomy treated with a laparoscopic choledochoduodenal anastomosis. This technique offers an excellent alternative to solve highly complex cases in a single surgical time, allowing the patient to restore his original functionality prior to the biliary duct lesion.

Surgical Management of Complex Bile Duct Injuries in Specialized Hepatopancreatobiliary (HPB) Unit

Objective: To describe the surgical management of complex bile duct injuries in a specialized hepatopancreatobiliary unit. Design of the Study: It was a retrospective study. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: This retrospective study includes 80 patients of bile duct injury who underwent surgical correction of bile duct injury at specialized Hepatopancreatobiliary [HPB] and liver transplant department of Shaikh Zayed Hospital Lahore. All the subjects were evaluated by retrospectively. The information regarding primary operative procedure, drain placement, T-tube placement, presentation, hospital stay, Liver Function Tests [LFTs], level of biliary tract injury and type of surgical procedure obtained from patients records. Results of the Study: During the study period 80 patients – 65 females and 15 male were operated for bile duct injury. Mean age was 39.89 years range 21 to 65 years. Hospital stay ranges from 9 to 36 days with mean of 16.18 days. Patients underwent open cholecystectomy, 43.8% laparoscopic cholecystectomy and in 3 patients procedure was converted from laparoscopic to open. 52.5% patients underwent open cholecystectomy, 43.8 laparoscopic cholecystectomy and in 3 patient’s procedure was converted from laparoscopic to open. Conclusion: It is concluded that the correct long lasting and physiological method to treat injuries of bile duct is only surgical repair. Although, surgical repair of bile duct must be operated by skilled hepatopancreaticobiliary surgeons. A practical method which is selected appropriately and implemented successfully has surely improved surgical outcome without any problem faced during the operation. Keywords: Hepatopancreatobiliary, Bile Duct Injury, Surgical Management