YATROGENIC BILE DUCT INJURIES (BASED OF THE TVER REGION DATA)

Abstract

Laparoscopic cholecystectomy (LC) is one of the most frequent operations. The significance of the problem with iatrogenic unwitting bile duct injuries (BDI) remains extremely actual up to the present. Our aim was to analyze the situation in the Tver region associated with this complication. From 1994 to 2017, 11280 cholecystectomies were performed in the surgical department of the regional hospital in Tver, while LC was performed in 10396 (92.9%) patients. Patients with "severe" unwitting BDI (42) from the whole region were concentrated in this clinic; we analyzed their treatment. Intraoperatively unwitting BDI were diagnosed only in 8 (19.0%) patients. The most frequent mechanism of trauma was “carving out” of bile duct fragment. In some cases, the cause of iatrogenic was the unjustifiably hasty intersection of tubular structures in the zone of the Calot triangle without their proper identification. In 15 (35.7%) patients, surgical correction of this complication was carried out in two stages. All patients eventually formed an end-to-side hepatico-, hepato- or bihepato- jejuno Roux-en-Y anastomosis, while in 36 (85.7%) patients - with replaceable transhepatic drains according to Saypol-Kurian. All patients recovered, there was no hospital mortality. In our opinion, the problem of continuous training and improvement of operational techniques (including simulation ones) for both young and “mature” surgeons remains relevant. It is necessary to use a typical tactic for the management of patients with unwitting BDI and concentrate them in a specialized hospital.