Iatrogenic bile duct injury with loss of confluence.

Aim: To describe our experience concerning the surgical treatment of Strasberg E-4 (Bismuth IV) bile duct injuries.

Methods: In an 18-year period, among 603 patients referred to our hospital for surgical treatment of complex bile duct injuries, 53 presented involvement of the hilar confluence classified as Strasberg E4 injuries. Imagenological studies, mainly magnetic resonance imaging showed a loss of confluence.

Liver segment IV hypoplasia as a risk factor for bile duct injury.

Introduction: Bile duct injury remains constant in the era of laparoscopic cholecystectomy and misidentification of structures remains one of the most common causes of such injuries. Abnormalities in liver segment IV, which is fully visible during laparoscopic cholecystectomy, may contribute to misidentification as proposed herein.

Methods: We describe the case of a 36-year-old female who had a bile duct injury during a laparoscopic cholecystectomy where the surgeon noticed an unusually small distance between the gallbladder and the round ligament.

Right and left partial iatrogenic injuries of the biliary tree. Therapeutic options.

Background: Bile duct injuries (BDI) have a wide array of presentation. Left partial injuries (Strasberg D) of the hepatic duct are the result of excessive traction, which dissects the hepatic hilum and provokes medial perforations without continuity loss. Right partial injuries (Strasberg A, B and C) are produced by direct damage to the hepatic duct or isolated injury to the right and accessory ducts.

Components-separation technique for closure of transverse non-midline abdominal wall incisional hernia.

The components-separation technique was originally described and has been popularised for the treatment of large midline hernias. In this report, we indicate that components separation can also be applied for the closure of transverse non-midline hernias, provided the largest diameter of the defect (i.e.