PMC7530199_01
1A: MRCP revealing choledocholithiasis. 1B: MRCP, the gallstone can be seen eroding the gallbladder wall into the common bile duct.
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A type III Mirizzi was diagnosed (Fig. 1A, B), and surgical consultation was required.
2A: Multiples adhesions on laparoscopy. 2B: Gallbladder with the cholecystocholedochal fistula and the stone. 2C: Fistula.
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Using an ultrasonic energy device, the adhesions were released, and the gallbladder was exposed. (Fig. 2A, B).
3A: Gallbladder free flap sutured to the common bile duct. 3B: Intraoperative cholangiogram without leaks.
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As the tissue around the common bile duct was fragile and could not be closed, the viable gallbladder was dissected to form a free flap to repair the defect. (Fig. 3A) The flap was sutured around the common bile duct using a 5-0 synthetic absorbable monofilament (PDS Johnson & Johnson-Ethicon), and a T Tube drain was placed. After extensive irrigation and without evidence of leaks (Fig. 3B), a drain was left in this area, and the surgery was completed without difficulties.