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Abstract : |
Iatrogenic bile duct injury carries a high rate of morbidity. After the introduction of laparoscopiccholecystectomy the incidence of these injuries has at least doubled, and even after the learningcurve, the incidence has remained of about 0.5%. Etiology of the iatrogenic biliary injuries is theresult of the anatomical conditions (biliary or vascular anomalies), pathology (acute cholecystitis,adhesions), technical equipment, surgeon (the lerning curve). The type of the injuries, thediagnostic procedures and therapeutic approach are discussed. Most of the minor bile duct injuries,including cystic duct leaks and bile duct strictures, are well treatable with endoscopic techniques,whereas most of the major injuries require operative treatment, which at optimal circumstancesgives good results. Interdisciplinary cooperation and early referral to an experienced center iscrucial in the management of these iatrogenic lesions. The best â€â€treatmentâ€‌ for this iatrogenicpathology is prevention: surgical access adapted to morphology, good exposure of the hepatoduodenalspace, good identification of structures before tying, appropriate dissection, selectivecholangiography, great care with the use of electrosurgery., |
