Treatment of bile duct variation in Laparoscopic Cholecystectomy: report of 7 case

Abstract

Objective To explore treatment of bile duct variation in Laparoscopic Cholecystectom. Methods The author retrospectively analyzed the clinical data of 7 cases with bile duct variation in 2 000 patients performing Laparoscopic Cholecystectomy. Among the 7 cases,2 cases had small hepatic duct openings in the gallbladder bed;2 cases had cystic duct openings in the right hepatic duct;2 cases had accessory right hepatic duct;and one case had rare variation whose right hepatic bile duct and the jejunum connect together.2 cases of the first variation had no bile leakage,adopting the suture method in LC.Among 2 cases of the second variation (all found in LC),one case had bile spillage in the junction of the cystic duct and the right hepatic duct, so the operator converses to laparotomy, cuts the gallbladder, sutures the break, and the patient had no bile leakage at last;The other one case was anatomized clearly under the cavity mirror. Among 2 cases of the third variation, one had no bile leakage,whose accessory hepatic duct was ligated in LC.The other one case had bile leakage after LC,so the operator converses to laparotomy, clips the accessory hepatic duct,and extract the drainage tube until there was no bile drainage.The last case was mistaken and cut it, the next day biliary peritonitis appeared, so the bile leakage was sewed up under the laparoscope. Results The seven cases were followed 1~3 years, they had no jaundice and their liver function was normal. Conclusion Carefully dissect Calot's triangle in LC, observe bile leakage after LC; improve the level of understanding and dealing bile duct variation in LC,don't cut the duct which is known to us. We should treat differently according to particular case. Key words: Cholecystectomy; Laparoscope; Bile duct variation