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Abstract
The first laparoscopic cholecystectomy was done successfully in 1985. Since that time, it is performed by the same method. Laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as gold standard in surgical management of cholelithiasis. The surgical principle is based on primary access to the cystic pedicle via the triangle of Calot. Although laparoscopic cholecystectomy is safe, it has its own set of complications. Biliary injuries during laparoscopic cholecystectomy occur more frequently when compared to open surgery. They occur twice to three times more frequent than post-open surgery. The incidence of biliary injury post-open cholecystectomy is 0.2% which has risen to between 0.4-1.3% postlaparoscopic cholecystectomy. The most common mechanism, often called the ”classic injury”, is the misidentification of the cystic duct and the common bile duct during the surgical dissection of Calot’s triangle. Bile duct injury is a catastrophic complication and adds significantly to the morbidity of the patients; therefore, early detection is mandatory to avoid as much complications as possible. The incidence of biliary injuries after cholecystectomy might be kept down by understanding the exact anatomical knowledge with its variants, meticulous surgical dissection technique, intraoperative cholangiography and early consideration fo conversion to open technique. Diagnosis of biliary injuries after laparoscopic cholecystectomy is done clinically and by cholangiography. Early diagnosis of patients with suspected biliary injury is important to get the best results of repair. Intraoperative diagnosis is thought to have the best consequences concerning the outcome of repair. The management of these injuries requires good planning, preoperative preparation, highly sophisticated interventional techniques and advanced hepatobiliary surgical procedures. Coordinated efforts between radiologists, endoscopist, and surgeons are necessary to optimize the management of patients with major bile duct injury, suggesting that patients with biliary complications of laparoscopic cholecystectomy should be referred to specialty centers for optima care. Benign biliary injuries and strictures are caused by surgical trauma in about 95% of cases. The most common cause of major BDI during LC is mistaking the CBD for the CD. Most bilomas can be managed successfully with noninvasive methods. Major biliary injury usually requires reoperation. Roux-en-Y hepaticojejunostomy are usually necessary for CBD repair. Knowledge about these complications is essential for their prevention. Additionally, this understanding helps the laparoscopic surgeon to identify possible complications intraoperatively. It is the timely recognition, which in many cases allows the surgeon to manage the complication laparoscopically and thereby preserve the patient some of the benefits of the minimally invasive approach. Prevention of injury to the duct depends on combination of technical skills, experience and a thorough knowledge of the normal anatomy and its variations in the hilum of the liver.
Objectives: The aim of the essay is to assess the iatrogenic causes of bile duct injuries following laparoscopic cholecystectomy, presentation, types, and management in early and late cases.