Biliary Tract Injuries during Laparoscopic Cholecystectomy

Abstract

The first laparoscopic cholecystectomy was done successfully in 1985. Since that time it is performed by the same method. Laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as gold standard in surgical management of cholelithiasis. The surgical principle is based on primary access to the cystic pedicle via the triangle of Calot. Although laparoscopic cholecystectomy is safe, it has its own set of complications. Biliary injuries during laparoscopic cholecystectomy occur more frequently when compared to open surgery. They occur twice to three times more frequent than post open surgery. The incidence of biliary injury post open cholecystectomy is 0.2% which has risen to between 0.4-1.3% post laparoscopic cholecystectomy. The most common mechanism, often called the "classic injury", is the misidentification of the cystic duct and the common bile duct during the surgical dissection of Calot's triangle. Bile duct injury is a catastrophic complication and adds significantly to the morbidity of the patients; therefore early detection is mandatory to avoid as much complication as possible. The incidence of biliary injuries after cholecystectomy might be kept down by understanding the exact anatomical knowledge with its variants, meticulous surgical dissection technique, intraoperative cholangiography and early consideration of conversion to open technique Diagnosis of biliary injuries after laparoscopic cholecystectomy is done clinically and by cholangiography. Early diagnosis of patients with suspected biliary injury is important to get the best results of repair. Intraoperative diagnosis is thought to have the best consequences concerning the outcome of repair.