Abstract
SummaryLaparoscopic cholecystectomy has become the standard procedure worldwide since the early 1990s for those patients whose gallbladder has to be removed as part of their underlying disease (NIH Consensus Statement 1992). The most common complication is iatrogenic bile duct injury, which has not improved significantly since the introduction of open laparoscopic cholecystectomy as compared with open cholecystectomy. The intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. In order to minimize this risk, a number of improved operative techniques and behavioral measures have been formulated. Here, we present methodological and operative possibilities as well as techniques that in unclear situations can help to minimize the risk of intraoperative injuries of the biliary tract and the accompanying vascular system.
Highlights
Bile duct injuries have long-term consequences that are associated with a lower quality of life as well as with reduced life expectancy [1, 2]
The cystic artery is found in more than 70% of hepatocystic triangles and more than 30% is outside the Calot triangle
Intraoperative cholangiography enables the identification of the extra- and intrahepatic bile duct system as well as the differentiation between the cystic duct and the common bile duct
Summary
Bile duct injuries have long-term consequences that are associated with a lower quality of life as well as with reduced life expectancy [1, 2]. After the introduction of laparoscopic cholecystectomy, the injury rate within the learning curve averaged 1.5%, significantly higher than that with open cholecystectomy [3, 4]
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