Bridging Post Cholecystectomy CBD Transections through a Novel Drain loop Technique – How I do it !

Abstract Complete transection of the common bile duct (CBD) is a complication of Cholecystectomy which can be difficult to repair by surgery and management by Endoscopic Retrograde Cholangiography is also difficult due to failure of negotiation of wire across the transected ends of the CBD. Patients usually present in a state of sepsis with bile leak and continuous output of bile from the surgical drains. After failure of ERCP, percutaneous approach can be tried by interventional Radiologist, however passing a guide wire across cut ends of CBD is difficult even by routine percutaneous approach. We describe a novel technique which we used in three patients of CBD transection to bridge the wire across the transected ends of CBD facilitating the placement of plastic stents across the duct transection. Our technique helps in rescuing patients from a state of sepsis and morbidity and can be an option to avoid the often-difficult surgery in cases of interruption of biliary tree. If required surgery can be performed later in elective conditions when patient’s general condition and technical availability of surgical expertise is feasible. “Level of Evidence: Level 5, Mechanism based reasoning.”