This video illustrates the key aspects of laparoscopic hepatico-duodenostomy for common bile duct (CBD) injury. We present the case of a 30 year old female, morbidly obese who had open gastric bypass and was referred to us after CBD injury during laparoscopic cholecystectomy. The patient was treated with a 10-Fr transhepatic (TH) drain that required multiple replacements. A preoperative cholangiogram revealed dilatation of the intrahepatic ducts and a short segment of common hepatic duct without common bile duct.

A laparoscopic hepatico-duodenostomy was performed with the patient in the split-leg position. The CBD was exposed after lysis of adhesions. An intraoperative cholangiogram confirmed the correct site of the hepatic duct. Then, the CBD was opened and a cholangioscopy showed no evidence of stones or obstruction of the main ducts. The anastomosis was performed without tension by using two running sutures of 4-0 Monocryl. Finally, a drain was placed near the anastomosis and a cholangiogram through the TH drain showed no leaks and good flow of contrast to the duodenum.

The patient tolerated well the procedure. She was discharged home on postop day 3 uneventfully. On postop day 8, a cholangiogram did not show any leak.

We conclude that laparoscopic hepatico-duodenostomy for CBD injury is a safe and feasible alternative to hepatico-jejunostomy after Roux-En-Y gastric bypass.