Extrahepatic bile duct injury during laparoscopic cholecystectomy -- own material.

摘要

BACKGROUND: Despite recognised advantages of laparoscopy, the damage ofextrahepatic bile ducts during cholecystectomy is a subject of ongoing discussions, as such injuriesare more frequent comparing with open surgery.MATERIAL/METHODS: The analysis included 6873 patients whounderwent laparoscopic cholecystectomy. The study group comprised both the patients after elective surgerydue to symptomatic cholelithiasis and patients after emergency procedures necessitated by acute cholecystitis.RESULTS:Common bile duct was damaged in 9 patients. Five people had their main bile duct transected, in 2 peopleit was partial excision, and in the other 2 subjects - puncture damage with electrocoagulation took place.In seven cases, the damage was diagnosed still during laparoscopy and conversion to open surgery wasperformed. In two subjects the damage was diagnosed in postoperative period and it was subsequently confirmedby ERCP. Reconstructive surgery included: CBD suturing with interrupted stitches, end-to-end anastomosisover T-tube and Roux-en-Y bilioenteric anastomosis. Good postoperative outcome was obtained in 6 patients.One subject required repeated endoscopic dilatation and placement due to recurrent cholangitis. Two patientsdied due to upper gastrointestinal bleeding and multiple organ failure.CONCLUSIONS: Extrahepatic bileduct injury remains a dangerous complication following cholecystectomy. It is more likely to occur incase of anomalous anatomy of bile ducts, inflammatory or malignant infiltration and technical errorsof an operating surgeon. It is very important to diagnose the damage early enough, preferably still duringlaparoscopy. Imaging investigations (ultrasound, ERCP, MRCP, cholangiography) may be helpful in establishingthe diagnosis during the postoperative period.