engleski

The lesion of the main bile duct by laparoscopic cholecystectomy

The lesion of the main bile duct is due to its frequency and the complicated operational treatment the most difficult complication of laparoscopic cholecystectomy. The frequency of hepaticocholedochus lesion is evaluated in several multicentric retrospective studies, and it comes to 0.5 – 0.9%. 1500 patients were subjected to laparoscopic cholecystectomy in our clinics in the period from November 1994 to June 1999. The iatrogenic lesion of hepaticocholedochus occured in 7 female patients (0.46%). Their average age was 48 years (26-71 years). The complete structural lesion of hepaticocholedochus (Siewert IV) occured in 5 patients. The partial tangential lesion of hepaticocholedochus (Siewert III) occured in one patient. The late narrowing without the obvious intra-operational trauma of the main bile duct (Siewert II) occured in one patient. The primary reconstructive operation was performed in 2 patients. The secondary reconstruction was performed in 5 patients. The defect of hepaticocholedochus was solved by the direct suture and „T“ drain in one patient. In 5 patients the reconstruction was performed by the biliodigestive hepaticojejunoanastomosis according to Roux. In one patient the same anastomosis was performed by the type of „omega“ whorl. The average post-operative time of patients monitoring was short, and it comes to 14 months (4-28 months). The post-operative mortality of the patients operated due to the lesion of the main bile duct didn´t occured, as well as in those who were cholecystectomed endoscopicaly. The secundar operative reconstructive surgery was performed after 3-12 days upon the first operation and the lesion of the main bile duct. The average hospitalisation time was 29 days (9-44 days). The structural lesion – complete transsection (Siewert IV), was also according to our experience the dominant injury of the main bile duct. It represents the speciality of the laparoscopic cholecystectomy and it requires the highly demanding operative reparation. We believe that the application of the proven principles of the open surgery represents the best prevention of the biliar lesion in laparoscopic cholecystectomy, as well as the readiness for early conversion into the open operative intervention.

lesion; main bile duct; laparoscopic cholecystectomy

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