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Complicated laparoscopic cholecystectomy with bile leak: management strategy

P Pessaux, MD, PhD G Philouze, MD D Mutter, MD, PhD, FACS J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA JB Bertin, MS S Osailan, MD
Epublication WebSurg.com, Mar 2019;19(03). URL: http://websurg.com/doi/vd01en5542

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  • 2019-03-14
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Laparoscopic cholecystectomy may be rendered particularly complicated due to several conditions such as hepatomegaly or an advanced inflammatory state. Technical difficulties may be accountable for intraoperative complications, such as biliary leakage although surgeons comply with well-established safety guidelines such as the "critical view of safety" prior to the division of pedicular structures. This is the case of a morbidly obese 69-year-old male patient who was operated on three months after an episode of cholangitis medically treated and managed with ERCP and endoscopic sphincterotomy with a favorable evolution. During laparoscopic cholecystectomy, the cystic pedicle presents an inflammatory aspect, making the exposure and the surgical procedure particularly uneasy to perform in this obese patient. During dissection, bile leakage was evidenced. This video shows a therapeutic strategy to handle such a case, with the initial objective of preventing any common bile duct injury.