Prevention and management of bile duct injuries during laparoscopic surgery

Chowbey, P.K. (2002) Prevention and management of bile duct injuries during laparoscopic surgery. In: CME & Video Conference on Hepatobiliary Disorders, 23-24 March 2002, Delhi, India.

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Abstract

There was a reported higher incidence of common bile duct injuries when laparoscopic cholecystectomy was first introduced about a decade ago. With any new procedure, there is a likelihood of an increase in the number of complications during the learning curve. With increasing experience the areas or situations having a higher probability of causing the complication get identified. Seventy percent of these injuries are claimed to occur in surgeries classified as simple laparoscopic cholecystectomy. With our experience of over 15000 laparoscopic cholecystectomies, we have identified certain anatomical situations where there is a higher likelihood of injuring the CBD. These situations include a sessile gall bladder, especially with a narrow CBD, a lax CBD getting easily tented by traction on Hartmann pouch and a short cystic duct with the CBD in close proximity to the duct and posterior gall bladder wall. Also, other well documented factors known to contribute to a greater incidence of CBD injuries include poor vision, excessive bleeding and anatomical anomalies like Mirizzis syndrome. The basic principle to avoid injuries in such situation is to open a wide posterior window upto the liver bed and to ensure that there is no structure going back to the porta hepatis before applying the clips to the cystic duct. Protocol for management of CBD injuries does not defer from what has been followed in past except for the fact that the surgical correction in the form of bilio-enteric bypass can now be performed laparoscopically.

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