A case of cystic duct drainage into the left intrahepatic duct and the importance of laparoscopic fundus-first cholecystectomy for prevention of bile duct injury.
The laparoscopic cholecystectomy is the gold standard for the treatment of cholecystolithiasis, although it has been reported that the incidence of bile duct injury is higher for this method than for conventional open surgery. These injuries are mainly attributable to a misunderstanding of the biliary tract anatomy owing to severe cholecystitis, large impacted stones, and anatomic variations. In this paper, we report on the successful treatment of a 59-year-old male patient with cholecystolithiasis accompanied with extremely unusual biliary junction, in which the cystic duct drained into the left hepatic duct while using the laparoscopic fundus-first-cholecystectomy approach (i.e., the doom down technique) without any serious intraoperative complications. If the doom-down technique was not indicated in this particular case, the authors believe that a careless division of the cystic duct may have resulted in operative morbidity.
Yamakawa
Tatsuo
T
Department of Surgery, Teikyo University Hospital at Mizonokuchi, Kawasaki, Japan. yamakawa@med.teikyo-u.ac.jp
Zhang
Tianhua
T
Midorikawa
Yutaka
Y
Ishiyama
Junji
J
Takahashi
Katsuyuki
K
Sugiyama
Yasuyuki
Y
D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D004322:Drainage; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged