Page 16 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE Common Bile Duct Injuries During Laparoscopic Cholecystectomy

Common Bile Duct Injuries During Laparoscopic

Cholecystectomy

BV Sridhar Varma
General Surgeon and Endoscopist, Neela Nursing Home, Bhadrachalam, Khammam, Andhra Pradesh, India

Abstract
Iatrogenic common bile duct injuries are the worst complication of laparoscopic cholecystectomy. The goal of this study is to increase
awareness of the problem and educate surgeons about the consequences and proper management of these injuries. Cholecystectomy
is the most common gastrointestinal operation performed. Laparoscopic cholecystectomy was first performed by Erich Muhe in 1985
in Germany. In 1987 laparoscopically complete removal of GB was performed by Mourat in Lyon, France. The widespread acceptance
of laparoscopic cholecystectomy was based on anticipated reduction in postoperative pain, minimal tissue injury intraoperatively and
early return to work. It has now become a gold standard for the treatment for GB stone in experience and safe hand.
Many articles source that soon after introduction, how it became clear that laparoscopic cholecystectomy was associated with unique
complication of higher rate of CBD injures compared with open cholecystectomy. Highest rates of CBD injuries where reported in early
1990s when laparoscopic cholecystectomy was introduced, suggesting a learning curve effect. In a review by Strasburg et al and Roslyl
et al, the incidence of billiary injuries during open cholecystectomy was found 0.2-0.3%. The review by Strasburg et al in 1995 of more
than 124000 laparoscopic cholecystectomies reported in literature found the incidence of major bile duct injuries to be 0.5%. Even as the
surgeon passed through learning curve and has reached “steady-state” and there has been no significant improvement in the incidence
of billiary duct injuries. The impact of major CBD injuries is staggering to both the patient and health care system.
Keywords: CBD injury, laparoscopic cholecystectomy, complication of laparoscopy.

INTRODUCTION complication, long-term detrimental effect of bilduct injuries.
The 15 no of quality citations reviewed were selected for these
Article study shows that about 95% bile injuries are minor and reviews.
were irrelevant to patients out come and only 5% were major The criteria for selection was the following:
and almost always required a technologically demanding and 1. At least 40 cases should be included the study especially
expensive operative reconstruction of billiary tree. Inspitet of for complicated cases.
proper diagnosis and treatment of major bile duct injuries 2. Method of analysis: Retrospective analysis.
mortality rate was found to be10-12%. 3. Type of procedure: Laparoscopic cholecystectomy using
As noted by WHO in 1947 health is not limited to absence
four port.
of disease, fulfill of physical, mental, and social well-being, 4. The institution were the procedure was practice (preference
therefore the extent to which a procedure and disease process for those specialist for laparoscopic surgery).
impact the physical, psychologies and social aspect of patient 5. Laparoscopic cholecystectomy practice: In all studies
life and filling of well-being. Therefore to truly access a patient laparoscopy.
out come after CBD injury one must not measure the usual 6. Cholecystectomy was performed with a standard technique
objective clinical outcome, but also evaluate the patients using four ports.
subjective health related quality of life. 7. Creation of pneumoperitoneum with CO .
In most of study it was found health related quality of life 2
and time to returned to work among the patients who had CBD 8. Insertion of port followed by diagnostic laparoscopic.
9. Holding the funduss by assistant through four ports.
injuries during laparoscopic cholecystectomy and under went 10. Dissections of visceral peritoneum.
treatment at secondary and tertiary center, out comes were 11. Dissections of Calot’s triangle and homeostasis maintain
compared with those under went uncomplicated laparoscopic by using various type of energized instrument.
cholecystectomy.
12. Clipping and division of cystic duct and artery.
13. Dissection of GB from liver bad.
MATERIAL AND METHOD
14. Extraction of GB and any spilled stone.
A literature search was performed using Google, Yahoo, 15. Irrigation of suction of operating field.
Springer link, Highwire press and the following search terms 16. Final diagnosis laparoscopy.
were used. Iatrogenic bile duct injuries, common bileduct injuries 17. Removal of instrument with complete exist of CO .
2
during laparoscopic cholecystectomy, postcholecystectomy 18. Closure of wound.
World Journal of Laparoscopic Surgery, September-December 2009;2(3):15-18 15