복강경 담낭절제술시 담도계 손상

Abstract

Background/Aims: The evidence that there is a significant increase in the number of bile duct injuries(BDI) during laparoscopic cholecystectomy(LD) is debatable. Through retrograde analysis of BDI, we aimed to find the possible preventive methods of BDI during LC.

Methods: We experienced 9 cases of BDI from 521 consecutive LCs. clinical manifestations, diagnostic methods, type of injuries, factors causing BDI and management of injuries were recorded. Mean follow-up period after operative treatment was 28 months .

Results: The incidence of BDI was higher after LC than open cholecystectomy. There were 6 BDI (3 cases found intraoperatively and 3 cases postoperatively) requiring biliary reconstruction and 3 bile leaks were treated by endoscopic retrograde biliary drainage. The methods employed for biliary reconstruction were biliary-enteric anastomosis (5 cases) or primacy repair (1 case). T-tube scent was used in all cases of biliary reconstruction. There were no deaths and all patients returned to their pre-injury activities after definite treatment.

Conclusions: It is suggested that all suspected BDI after LC require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be required if there is complete obstruction of the biliary tree or diffuse blliary peritonitis due to continued bile leak. Early recognition of bile duct injury is crucial to decrease morbidity and mortality rates. To prevent BDI during LC, dissection should be done near the GB side rather than the CBD side and minimal use of electrocautery is necessary. Conversion to open surgery should be considered when the exposure of Calot’s triangle is difficult.