title: [Value of identification of cystic duct, common bile duct, and common hepatic duct in prevention of bile duct injury during laparoscopic cholecystectomy].
abstract: OBJECTIVE
  To explore effective method to avoid iatrogenic bile duct injury during laparoscopic cholecystectomy (LC).
  
  
  METHODS
  10 492 patients underwent LC from May 1996 to May 2006, 8566 of them were treated by the method to identify the cystic duct, common hepatic duct, and common bile duct during LC (tri-duct method group), and the left 1926 cases whose cystic duct failed to be exposed easily were treated with the method to identify at least two of the 4 structures (cystic lymph node, Hartmann's pouch, cystic artery, and emptiness of cystic triangle) so as to help identify the cystic duct (tri-duct plus tri-structure group). The operating time, amount of blood loss, open conversion rate, and morbidity were compared between these 2 groups.
  
  
  RESULTS
  No cases of bile leakage or jaundice because of accidental injury of bile duct were found. The operating time of the tri-duct plus tri-structure group was (28 +/- 12) (15 - 52) min, significantly shorter than that of the tri-duct group [(38 +/- 16) (15 - 92) min, P < 0.05]. The open conversion rate of the tri-duct plus tri-structure group was 1.8%, significantly lower than that of the tri-duct group (8.7%, P < 0.05). There were no significant difference in the amount of blood loss and morbidity between the two groups (both P > 0.05).
  
  
  CONCLUSIONS
  The tri-structure method can not only confirm the cystic duct correctly, thus preventing iatrogenic bile duct injury, but also shorten the operating time and reduce the open conversion ratio during LC.
authors: Department of General Surgery, Shanxi Coal Centre Hospital, Taiyuan 030006, China. sunqxl@163.com
authors: Dian-Chen
authors: DC
authors: Wang
authors: Yong-Hong
authors: YH
authors: Dong
authors: Zhi
authors: Z
authors: Chen
authors: Shu-Sheng
authors: SS
authors: Wu
authors: Xiao-Gang
authors: XG
authors: Bi
authors: Wei-Dong
authors: WD
authors: DI
authors: Run-Fu
authors: RF
authors: Zhang
authors: Zhan-Ke
authors: ZK
authors: Li
authors: Yan-Long
authors: YL
authors: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003549:Cystic Duct / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D055815:Young Adult