Objective To investigate the prevention and treatment strategy of bile duct injury (BDI) in laparoscopic cholecystectomy (LC). MethodsLatest progress was reviewed based on recent documents and the experience on BDI in LC in our department. ResultsWith the popularity of LC, BDI in LC is increasing. The reasons include illegibility and variability of local anatomy in gallbladder trigone,injury caused by galvanothermy, as well as operator’s overconfidence. In order to prevent BDI, we should apply more blunt dissection, not to use electrocogulation if possible and to study local anatomy and its variance clearly. The common bile duct and common hepatic duct should be clearly identified. Intraoperative cholangiography, laparoscopic ultrasonography and hepatobiliary scintigraphy are selections as necessary.The treatment of BDI depends on the type of BDI and its site and local condition.The treatment includes end to end anastomosis, repairing the defect, choledochoduodenostomy, RouxenY choledochojejunostomy and so on. T tube should be maintained in place for more than half a year after operation.Conclusion The key to improve the prognosis of BDI is prevention and treatment in proper time and in correct way.
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
【Abstract】ObjectiveTo evaluate the injury of common bile duct in immediate removal of the ligation in cholecystectomy. MethodsEighteen healthy Japanese rabbits were selected and divided into three groups randomly: A group treated with simple cholecystectomy, B group with cholecystectomy plus common bile duct crossligation and C group with cholecystectomy plus hepatic bile duct conjunction “Y”type ligation. The ligation was removed after 5 min in B and C groups. The levels of serum transaminase and bilirubin and pathological changes of bile duct and liver in each group were observed respectively. ResultsThere were no statistic difference in the levels of GPT, GOT, total bilirubin (TB), direct bilirubin (DB) and DB/TB on 12 hours before operation and the 1st and 7th day after operation between A and ligation groups (Pgt;0.05). But there were statistic difference in the those indexes and pathological changes of bile duct and liver between A and ligation groups on the 30th and 90th day after operation (Plt;0.05). ConclusionDuring cholecystectomy, immediate removal of common bile duct ligation doesn’t affect shortterm results, but the long-term results are bile duct stricture and obstruction.
ObjectiveTo explore the causes of bile duct injury due to laparoscopic cholecystectomy (LC) and the preventive methods. MethodsA total of 18 patients with bile duct injury (with the occurrence rate of 0.4%) after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old[averaging (42.3±3.6) years old]. The clinical data of the patients were retrospectively analyzed. ResultsIn the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome withⅠ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. ConclusionThe operator's experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.