Abstract
Objective: The present study was undertaken to find measures for preventing injury to the biliary tract during laparoscopic cholecystectomy as well as a strategy for managing such injuries. Patients and Methods: We reviewed clinical records of the patients who underwent laparo scopic cholecystectomy during the period of February 1,1991 through January 31,2001 at our institute, and analyzed the type and site, as well as causative factors, of biliary tract injuries.
Results: Ten (0.98%) of 1,022 consecutive patients had injury to the bil iary tract during laparoscopic cholecystectomy. Anatomical sites of the injuries included the common bile duct in 6 patients, common hepatic duct in 3, and accessory cystic duct in 1. Causes of the injuries included disorientation of surgical anatomy in 9 patients and inappropriate use of electrocautery in 1. Misinterpretations of the anatomy included the following; mistaking the common bile or hepatic duct for the cystic duct in 7 patients, and for the cystic artery in 1; overlooking the accessory cystic duct in 1.
Discussion and Conclusion: Most injuries to the biliary tract can be managed with relative ease, provided that such an injury could be found and treated during the surgery. Therefore, intraoperative cholangiography should be performed routinely for the detection of possible biliary injury. We would like to emphasize that biliary tract injuries must be treated appropriately depending on the degree of injury as well as the timing of detection of injury. Measures for preventing injury to the biliary tract would include careful operative maneuvers, and accurate pre-and intra-operative recognition of surgical anatomy.
