Emergency right hepatectomy for porta hepatis injury during laparoscopic cholecystectomy

INTRODUCTION

Laparoscopic cholecystectomy is the surgical procedure of choice for symptomatic gallstones. The incidence of bile duct injury following laparoscopic cholecystectomy is around 0.62% and, when vascular injuries also occur, the surgeon is faced with is a serious complication¹.Morbidity and mortality increase drastically when bile-duct and vascular injuries occur simultaneously and a successful outcome is unlikely when diagnosis of these is delayed. The extent of liver damage and the need for liver resection or transplant significantly influence the progress of patients with such injuries.

CASE REPORT

A 36-year-old female with symptomatic colelithiasis was referred for elective laparoscopic cholecystectomy. During the surgery, the chronic inflammatory process deforming the anatomy of the porta hepatis and the appearance of bleeding and bile in the surgical field obliged the surgeons to revert to the conventional procedure (open cholecystectomy), which involves a subcostal incision on the right hand side. Extensive hemostasis was carried out using sutures, clips and diathermy. The assistant surgeon decided to call in the surgeons from the hepato-biliary surgery group. The new team immediately increased the size of the incision (extending it to the subcostal area on the left hand side). Almost complete damage to the elements of the porta hepatis was found: ligature and section of the right portal branch; ligature and section of the right hepatic artery; ligature and section of the common hepatic duct on bifurcation; ligature and almost complete section of the left hepatic artery.