The Video Content has been made available for educational purposes only for surgical training of SIRIRAJ surgical resident and HPB fellowship training program**
The KEY of biliary enteric anastomosis revision after complex bile duct injury is not only performing a good anastomosis but also a good identification of anatomy. Lysis adhesion at this area should be performed very meticulously, avoiding further collateral damage to important structure such as hepatic artery or portal vein, which could be the cause of anastomosis failure and critical post operative complication. Hepaticojejunostomy anastomosis should be performed in well vascularized bile duct, tension free and no fibrosis of bile duct. Moreover, diameter of anastomosis should be larger than 1 cm if possible, to prevent anastomosis stricture in the future.
This is nearly uncut VDO. VDO speed was 2x, you can skip some parts of VDO such as dismantle previous anastomosis and lysis adhesion at RUQ area (at 0:28 - 6:50). Important steps were marked as chapters in timeline.
Please enjoy.
Chapters
0:00 Pre-operative imaging
0:08 Begin operation
12:00 Hepatoduodenaligament dissection, vital structure identification process
16:00 ICG fluorescence imaging for intraoperative bile duct identification
22:40 HJ anastomosis
42:05 Drain placement
