engleski

Functional liver injury caused by monopolar cauterisation during laparoscopic cholecystectomy as the predictor of possible late stricture of the common bile duct

The open debate about the causative agent of late postoperative stricture of the common bile duct, after the laparoscopic cholecystectomy (Siewert II injury) still exists. Thermal injury caused by monopolar cauter, or excessive manipulation with common bile duct during laparoscopic procedure where accused. The purpose of authors is to present the result of research which included two groups of 20 patients treated by laparoscopic cholecystectomy. With first group we used monopolar cauter as thermic medical means and other group we treated by using harmonic ultrasonic knife as non-thermic medical means. Post surgical laboratories results which concern to functional liver damage such are: AST, ALT, biliribin, AP, RBC, Hemoglobin and WBC were compaired. Pathohistological analyses of extracted gallblader walls was done by using light microscope. Author conclusion was that using monopolar cauter, which produces high level of thermic energy is related to functional liver injury, which can be proved by higher serum levels of AST and ALT, and massive coagulative necrosis of all pathohistologic layers of the gallblader walls. On the other hand, postoperative levels of AST and ALT in group of patients treated by ultrasonic knife (smaller thermic – energy producer) were significantly lower. Besides that, coagulation necrosis affected only mucosis and submucosis, but not the external fibromuscular layer. According to this results our conclusion is: using of monopolar cauter may cause electrocautery burns of common bile duct – main structure near gallblader, which is possible progress to stricture.

laparoscopic cholecystectomy; monopolar cauter; harmonic ultrasonic knife; stricture of the common bile duct

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