Bile Duct Reconstruction after Failed Laparoscopic Cholecystectomy: Literature Review

Abstract

   Today, the incidence of iatrogenic bile duct injury in laparoscopic cholecystectomy averages 0.4 % worldwide. In Russia, it accounted for 0.6 % in 2020. Side-to-side hepaticojejunostomy is the operation of choice with complete injury of the common bile duct. It is considered the safest operation, which preserves blood supply, provides wider anastomosis, ensures complete rehabilitation in 75–98 % of cases. Even in the centers of hepatobiliary surgery, the development of strictures after hepaticojejunostomy with traditional access after iatrogenic injury to the bile ducts occurs in 10–20 % of cases. Bile leakage develops in 3.0–3.3 % of cases. The success of reconstructive surgery largely depends on the precision technique of performing anastomosis, which can be ensured mainly by the quality of imaging. The possibility of laparoscopic hepaticojejunostomy after a common bile duct injury is currently a subject of debate, and only few publications report on its successful performance. Most surgeons prefer open anastomosis due to insufficient space for laparoscopic instruments. Although the advantages of laparoscopic surgery over traditional interventions are essential for this category of patients no less than for the others. Robotic laparoscopic surgery with its additional space for instruments in the complete absence of tremor, a twenty-fold increase in three-dimensional image, which increases the accuracy of tissue dissection and the precision of anastomotic sutures, can be an excellent option for working on thin tubular structures in the porta hepatis.