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Biliary complications associated with laparoscopic cholecystectomy--an analysis of common misconceptions.
BACKGROUND: Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; complications occur in the presence of difficult anatomy/pathology; injuries occur more proximally than at open cholecystectomy; most injuries a...
Autores principales: | , , , |
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Formato: | Texto |
Lenguaje: | English |
Publicado: |
Ulster Medical Society
2000
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449182/ https://www.ncbi.nlm.nih.gov/pubmed/11196720 |
Sumario: | BACKGROUND: Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; complications occur in the presence of difficult anatomy/pathology; injuries occur more proximally than at open cholecystectomy; most injuries are recognised immediately and most can be managed non-operatively. The aim of our study was to determine if these views are substantiated in clinical practice. METHODS: The mode of presentation, management and outcome of thirty-two patients referred to a hepatobiliary unit over a seven year period were analysed. RESULTS: In 72% of cases the initial operator was a consultant. Five of the 32 complications (16%) occurred in the presence of difficult anatomy/pathology. Two patients had proximal biliary tree injuries, the only mortalities (two) occurring in this group. Only 41% of injuries were detected immediately; 87% required surgical intervention, hepaticojejunostomy being the most common procedure performed (75%). CONCLUSION: Our study shows that the majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy/pathology, do not occur in the proximal biliary tree and are not recognised at the time of operation. Most injuries ultimately require major reconstructive surgery for definitive management. |
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