[Bile duct injuries in laparoscopic cholecystectomy].
Bile duct injuries are the most serious complications of laparoscopic cholecystectomy. Although the overall complications rate in laparoscopic cholecystectomy is significantly lower than in open cholecystectomy, bile duct injuries are more frequent. In this article we analyzed why and how they occur and if their prevention was possible. From May 1992 to May 1999, laparoscopic cholecystectomy was performed in 5651 patients by 17 surgeons and residents, with different experience but similar operative technique. In this period nine (0.16%) bile duct injuries occurred. Injuries were caused by seven operators. Number of operations by single surgeon before injury varied from 8 to 1477. Three patients with uncomplicated chronic cholecystitis had puncture or small bile duct laceration. Complete transection of main bile duct occurred in three patients and in one transection of right hepatic duct. The operative findings in two of them were acute cholecystitis, one had fibrosis in the triangle of Calot and one uncomplicated chronic cholecystitis. Bile duct strictures were found in two patients. Both had fibrosis in the triangle of Calot and in hepatic port. Dangerous pathologic findings were the main cause of injuries in 5 and inadequate surgical technique in 4 patients. In our opinion the education, critical state and experience are of main importance in avoidance and prevention of bile duct injures. We also plead for selective use of intraoperative cholangiography. In our opinion the intraoperative cholangiography has to be performed in all cases where the anatomy of the triangle of Calot is not clear.
Velnić
D
D
Kirurska klinika OB Sveti Duh, Sveti Duh 64, 10000 Zagreb.
Perko
Z
Z
Cala
Z
Z
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged