Restoration of bile duct patency. MCSC patient history

News 05/06/2022

In the Department of Radiosurgery of the MCSC named after A.S. Loginov, two patients underwent restoration of the patency of the bile duct after its complete intersection during laparoscopic surgery.

Two patients, one of whom is a young mother (a 23-year-old woman, a 1.5-year-old child), underwent operations in other hospitals in Moscow to remove gallstones (calculous cholecystitis). Due to the late treatment of surgeons, a long inflammatory process led to the appearance of tissue compaction around the gallbladder. This, in turn, caused technical difficulties during the operation and ultimately led to the intersection of the common bile duct. All the bile began to flow out through the drainage.

Reconstructive surgery was possible only after 2-3 months. All this time, patients would need to be carried out with drainage against the background of complete loss of bile, which negatively affects the condition of the body.

To eliminate bile losses, specialists tried to close the defect by installing a stent endoscopically (through the lumen of the duodenum). The operation was unsuccessful.

Attempts to pass through the defect zone by percutaneous transhepatic access were also unsuccessful. In all cases, the conductor string fell into the subhepatic space, and not into the part of the bile duct left after the operation (photo 1).

Then the doctors decided to conduct a combined intervention, namely the simultaneous use of two approaches – endoscopic and transhepatic.

Both conductors were conducted through the duct defect into the subhepatic space (Photo 2). Under the control of fluoroscopy, the transhepatic conductor was "captured" by an endoscopic instrument and delivered to the crossed bile duct (photos 3 and 4). After that, an external-internal drainage was installed, playing the role of a frame, on which the duct defect began to gradually close (photo 5). The secretion of bile through the safety drainage stopped.

It is possible that in the future both patients will still need reconstructive surgery. However, as time passes, it will be performed in more favorable conditions.

Today the young patient has become a mother again. The birth took place independently and successfully.