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Minimizing the risk of bile duct injury at laparoscopic cholecystectomy

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Abstract

The introduction of laparoscopic cholecystectomy (LC) has been associated with an increase in the incidence of operative bile duct injuries. An operative technique that involves commencing the laparoscopic dissection on the body of the gallbladder and dissecting toward the cystic duct has been developed that minimizes the risk of major duct injury. The aim of this study was to assess prospectivel the safety of this dissection technique. A group of 410 patients underwent LC for symptomatic cholelithiasis from January 1991 to December 1992. There was a single common hepatic duct injury: a small (1 mm) side hole in a patient with acute cholecystitis and choledocholithiasis. It was managed at open operation with exploration of the common bile duct and insertion of a T-tube. There were no partial or complete common bile duct transections in this series. We concluded that the technique of commencing the dissection on the gallbladder is safe and minimizes the risk of serious common bile duct injury at LC.

Résumé

Avec l'avènement de la cholécystectomie coelioscopique (CC), l'incidence des plaies des voies biliaires a augmenté. Une technique opératoire qui commence par la dissection du corps de la vésicule biliaire et qui va ensuite vers le canal cystique a été développée pour minimiser ce risque. L'objet de cette étude a été de tester la sûreté de cette technique. De Janvier 1991 à Décembre 1992, 410 patients ont eu une CC pour lithiase biliaire symptomatique. Une seule plaie de la voie biliaire principale, une plaie latérale de 1 mm, chez un patient ayant eu une cholécystite et un calcul de la voie biliaire principale, a été observé. Celle-ci a été traitée par laparotomie avec mise en place d'un drain de Kehr. Il n'y a eu aucune section partielle ou totale dans cette série. Cette technique de dissection est sûre et minimise le risque de plaie de la voie biliaire principale pendant la CC.

Resumen

La introducción de la colecistectomía laparoscópica (CL) se ha visto asociada con un incremento en la incidencia de lesiones operatorias de la vía biliar.

Se ha desarrollado una técnica operatoria consistente en comenzar la disección laparoscópica sobre el cuerpo de la vesícula biliar y continuar la disección hacia el canal cístico, técnica que tiene como propósito minimizar el riesgo de lesión de la vía biliar. El propósito del presente estudio fue valorar la seguridad de esta técnica de disección. Cuatrocientos diez pacientes fueron sometidos a CL por coletitiásis sintomática entre enero de 1991 y diciembre de 1992. Sólo se presentó un caso de lesión del canal hepático común y una perforación lateral pequeña (1 mm) en un paciente con colecistitis aguda y coledocolitiasis que fue manejada con exploración del canal colédoco e inserción de un tubo en T. No se registraron transecciones completas o parciales del colédoco.

En conclusión, la técnica de comenzar la disección sobre la vesícula biliar es segura y minimiza el riesgo de una lesión grave del colédoco en el curso de la CL.

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Authors and Affiliations

  1. Gastrointestinal Surgery and Liver Transplant Unit, Flinders Medical Center, 5042, Bedford Park, South Australia, Australia

    Michael R. Cox FRACS, M.S., Thomas G. Wilson FRACS, Philip L. Jeans FRACS, Robert T. A. Padbury FRACS, Ph.D. & James Toouli FRACS, Ph.D.

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  1. Michael R. Cox FRACS, M.S.
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  2. Thomas G. Wilson FRACS
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  3. Philip L. Jeans FRACS
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  4. Robert T. A. Padbury FRACS, Ph.D.
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  5. James Toouli FRACS, Ph.D.
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Cox, M.R., Wilson, T.G., Jeans, P.L. et al. Minimizing the risk of bile duct injury at laparoscopic cholecystectomy. World J. Surg. 18, 422–426 (1994). https://doi.org/10.1007/BF00316827

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