[From Langenbuch to Strasberg: the spectrum of bile duct injuries].
Bile duct injuries are the main serious complication of laparoscopy cholecystectomy. The frequency of this type of injuries rangers, between 1 to 3 in 1,000 cases and although this rate remains stables, their frequency has increased because of the increasing expansion of the indication of cholecystectomy. Each lesion is the individual in it's features as well as the scenario in which the surgeon faces it. Several classifications have been developed, but that developed by Strasberg most used nowadays. Intraoperative cholangiography has shown evidence in meta analytic studies that diminishes the frequency of lesions but does not abolish them. Conversion from laparoscope's to the open approach with ample and convincent dissection is probably the best maneuver to reduce the frequency of lesions, when any anatomical or technical doubt appears. No patient should be operated in critical condition. In this situation, biliary reconstruction has a secondary role and only drainage of the ducts (percutaneous or surgical) is indicated. Roux en Y hepatoyeyunostomy is the procedure of choice for almost all cases, leaving other types of procedures for selected cases. Transhepatic transanastomotical stents should be used according to the individual status of the patient when small, scared or inflamed ducts are found. High quality anastomosis is obtained when proper ducts are found. Sometimes high dissection of the ducts is needed in order to obtain adequate ducts. Nine of each ten cases are completely rehabilitated, obtaining a good quality of life.
Mercado
Miguel Angel
MA
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México, DF. mamercado@quetzal.innsz.mx
D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification* / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors