# Recanalization of the Duodenum Following a High-Grade Post-Laparoscopic Cholecystectomy Duodenal Injury: Personalized Approach Presentation and Systematic Review of Management Options

## TL;DR

A rare case of duodenal injury after laparoscopic cholecystectomy is presented, highlighting the need for personalized treatment approaches based on injury specifics and patient status.

## Contribution

The paper presents a rare case and a systematic review of management options for duodenal injuries following laparoscopic cholecystectomy.

## Key findings

- Duodenal injuries after laparoscopic cholecystectomy are rare but potentially fatal.
- Treatment approaches depend on injury recognition time, injury site and extent, and patient status.
- Personalized treatment strategies are recommended based on these factors.

## Abstract

Background: Laparoscopic cholecystectomy is considered the gold standard surgical technique for the treatment of gallbladder diseases worldwide. Nonetheless, despite its safety and popularity, it comes with certain complications. Duodenal injury is an extremely rare, but potentially fatal complication. The rarity of duodenal injuries, combined with under-reporting of incidents, has resulted in a scarcity of references in the international literature. Case Presentation: We present the case of a 72-year-old male patient, initially subjected to laparoscopic cholecystectomy that was intraoperatively converted to open cholecystectomy. During the laparoscopic approach, the patient experienced a major duodenal injury, which was treated intraoperatively using primary suturing. Upon postoperative failure of the indicated surgical treatment, extended individualized salvage surgery was performed, with an ultimately favorable outcome. Methods: When assessing the overall implications of this case, we conducted a review of the published literature in English, published up to November 2025 on patients with duodenal injury after exclusively laparoscopic cholecystectomy. Results: We then categorized the 105 cases described based on the therapeutic approach: surgical, conservative, and endoscopic, with a view to attempt to classify the available therapeutic options based on the time of diagnosis, the patient’s performance status, and the size and location of the injury. Conclusions: While laparoscopic cholecystectomy is a common surgical procedure, duodenal injuries remain rare. The treatment approach highly depends on the time of injury recognition, site and extent of the injury and patient’s status. Treatment should be personalized based on the aforementioned parameters.