Aguirre RR, Castañeda CP, García LJ, Martínez BA

Language: Spanish
References: 24
Page: 87-91
PDF size: 67.23 Kb.

ABSTRACT

Objective: To report the frequency of bile duct injury during laparoscopic cholecystectomy in a teaching hospital.
Setting: Second level health care regional general hospital.
Design: Prospective, observational, longitudinal study.
Patients and methods: From January 3, 1992 to January 3, 1998, we studied 1,126 patients subjected to laparoscopic cholecystectomy to assess how many suffered bile duct injury. Inclusion criterion was a major bile duct injury requiring surgical treatment.
Results: The bile duct was injured in four women, which corresponds to 0.36% of the total operated patients. Their average age was of 36 years, range 31 to 47 years. In two patients, the diagnosis of total section of the common bile duct was performed transoperatively and had to be converted to open surgery. In the other two patients, a circumferential lesion of the common hepatic duct was diagnosed on the 7th day after surgery, in no case was a transoperative cholangiography taken. Four different surgeons performed the surgeries, two with an experience of less than 50 laparoscopic cholecystectomies and two with more than 100 of these surgeries. Only in one case, did the lesion occur during a tutelary teaching session. No lesions occurred during the last 31 months of the study. To repair the biliary tract, Y-in-Roux biliary-digestive shunt was used in three cases and a common bile duct-common bile duct anastomosis in the other. No deaths occurred during or after surgery. Conclusion: The risk factors and the causes for bile duct injury must always be considered when performing a laparoscopic cholecystectomy. If the Calot triangle is not identified, a transoperative cholangiography must be taken. The frequency of bile duct injury was of 0.36%. Tutelary teaching did not increase the possibility of these lesions.

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