ASGE DDW Videos from Around the World | 2023-NOVEL USE OF CHOLANGIOSCOPY FOR RESTORATION OF A COMPLETELY TRANSECTED BILE DUCT AFTER A FAILED SURGICAL REVISION

NOVEL USE OF CHOLANGIOSCOPY FOR RESTORATION OF A COMPLETELY TRANSECTED BILE DUCT AFTER A FAILED SURGICAL REVISION

Video Transcription

Video Summary

In this video, a novel use of cholangioscopy is showcased for the restoration of a completely transected bile duct after a failed surgical revision. The video emphasizes that iatrogenic bile duct injury is a serious complication of laparoscopic cholecystectomy, impacting the patient's quality of life and survival. Endoscopic treatment is commonly used for most cases, but when a complete transection occurs, surgical revision is usually required. The video describes the case of a 33-year-old female with gangrenous cholecystitis who underwent laparoscopic cholecystectomy, resulting in a bile duct injury. Despite surgical and endoscopic interventions, a large volume bile leak occurred, prompting the use of cholangioscopy for further management. By manipulating the cholangioscope across the staple line and using both clangoscopic and fluoroscopic images, the opening into the disconnected bile duct was found. A guide wire was then passed into the left hepatic duct, and a modified stent was placed in the sigmoid-shaped bile duct to prevent migration. This approach successfully improved the bioleak, and the patient did not require further surgeries. The video concludes by recommending referral to a tertiary center experienced in the surgical and endoscopic management of bile duct injuries and considering cholangioscopy as a technique to avoid additional surgeries and liver transplantation.

Asset Subtitle

Video Plenary
Authors: Kenneth H. Park, Simon K. Lo

Keywords

cholangioscopy

bile duct restoration

iatrogenic bile duct injury

laparoscopic cholecystectomy

endoscopic treatment