الفهرس 
Anatomy & embryology of the biliary tract
Cell Signaling in Biliary DevelopmentOnly 14 pages are availabe for public view
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Abstract
Knowledge of anatomic variation is important in the
operative setting. When the usual appearance of structures is not
encountered, it can be tempting to fit abnormal findings within the
paradigm of what is normal. This practice can lead to errors and
injury. Intraoperative cholangiography can be helpful in
interpreting the anatomy and should be used liberally
Laparoscopic cholecystectomy has largely replaced open
cholecystectomy because of shorter hospital stay, faster recovery,
and lower overall morbidity. Unfortunately, however, the
morbidity due to bile duct injury has increased with the advent of
the laparoscopic approach
Visualization of this “critical view” is important in
preventing injury to the bile ducts. At this point two structures
(cystic artery and cystic duct) should be seen entering the
gallbladder.
The key to early recognition is to suspect a problem in any
patient who fails to do well following laparoscopic
cholecystectomy. Because these patients usually do extremely
well, any deviation from this should be recognized as a problem.
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Treatment of IBDI is complex and multidisciplinary. The
following factors need to be known: the type of injury, the
patient’s clinical condition, associated vascular damage, local
hospital factors, etc.
Endoscopic management is relatively simple, reversible,
and minimally invasive. Thus, endoscopic management should be
an integral part of the therapeutic algorithm in the majority of
patients with significant biliary tract injuries. However, the
success of endoscopic therapy depends upon the type of injury.
An attempt at endoscopic therapy does not preclude subsequent
surgical intervention and endoscopic stenting should be seen as a
possible definitive therapy and at the very least a bridge to surgery.
A multidisciplinary approach between biliary endoscopist,
surgeon and radiologist is required for managing these patients
Mismanagement can result in lifelong disability and chronic
liver disease. Given the unforgiving nature of the biliary tree,
favorable outcome requires a well-thought-out strategy and
attention to details
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Case selection is very important for efficient and safe
training in LC. Surgeons who are at the beginning of their learning
curve should be given easy cases to prevent unnecessary
conversions and morbidity. Difficult cases have to be recognized
preoperatively and operated by experienced surgeons. These cases
carry a high risk of conversion and complications.