Abstract
Although laparoscopic cholecystectomy (LC) has been widely accepted as the standard of care, it continues to have a higher complication rate than open cholecystectomy. Bile duct injury with LC has often been attributed to surgical inexperience, but it is also clear that aberrant bile ducts are present in a significant number of patients who sustain biliary injuries during these procedures. We present three cases of right sectoral hepatic duct injuries which occurred during LC and provide a discussion of the conditions which are likely to lead to these injuries, as part of a strategy to prevent them.
Highlights
Bile duct injuries remain one of the most devastating complications of both open and laparoscopic cholecystectomy (LC)
We present three cases of right sectoral duct injuries, two of which had right posterior sectoral duct (RPSD) injuries noted on intraoperative cholangiogram (IOC) (Strasberg type C injuries) (Figures 1, 2), while the third had a right sectoral duct injury noted on postoperative endoscopic retrograde cholangiopancreatography (ERCP) (Strasberg type A injuries) (Figure 3) (Table 1)
Two structures most often misidentified as the cystic duct (CD) are the common bile duct (CBD) or an aberrant right hepatic duct (RHD)
Summary
Laparoscopic cholecystectomy (LC) has been widely accepted as the standard of care, it continues to have a higher complication rate than open cholecystectomy. We present three cases of right sectoral hepatic duct injuries which occurred during LC and provide a discussion of the conditions which are likely to lead to these injuries, as part of a strategy to prevent them
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