Prevention of Common Bile Duct Injuries in Laparoscopic Cholecystectomy

Abstract

Despite advancement in training and technology since its introduction, more than 20 years ago, bile duct injuries continue to be two to three times more common than in open surgery causing significant morbidity and mortality. Hence, a review of the literature present on the internet on bile duct injuries in laparoscopic cholecystectomy was performed to review the causes of biliary injury and methods of prevention of such mishaps. There was a general consensus that careful dissection and correct interpretation of the anatomy avoids the complication of bile duct injury during cholecystectomy. Routine intraoperative cholangiography is associated with a lower incidence and early recognition of bile duct injury. A low threshold to conversion to open approach in case of uncertainty was also advocated.

¿Cómo evitar lesiones iatrogénicas de vía biliar en cirugía urgente de vesícula? El uso de verde de indocianina es una alternativa

“…B A de Iwashita 4,5 , los pasos a seguir para evitar una lesión de la vía biliar, entre los cuales destacan: 1) la importancia de la realización de una tracción efectiva de la vesícula; 2) obtener siempre la critical view e identificar el triángulo de Calot; 3) evitar lesiones térmicas disminuyendo el uso de una excesiva fulguración; y 4) evitar el clipaje a ciegas en casos de sangrado no identificado, pudiendo optar por la compresión en primer lugar hasta la identificación. En algunos centros de referencia holandeses sistematizan la documentación mediante fotografía o vídeo que muestre la obtención de dicha visión del triángulo hepatocístico previo al clipaje 6 . Dado que el punto clave es la identificación correcta de las estructuras, en los últimos años el uso de la fluoresceína se ha impuesto en el marco de la cirugía hepatobiliar.…”

Feasibility of Intracholecystic Injection of Methylene Blue to Visualise the Biliary Tree during Laparoscopic Cholecystectomy

“…Nevertheless, global incidence of CBD injury has remained fairly constant around 0.5%, as reported by various meta-analysis studies over a 15-year period. 5 Although there has been stress on the routine use of intra-operative cholangiography (IOC) in laparoscopic cholecystectomy to delineate the extra-hepatic biliary anatomy and to know the status of the common bile duct (CBD), its role remains controversial and selective use of IOC has been recommended by a significant number of authors. Additionally, the operation room conditions should be suitable for IOC, the necessity of some disposable equipment, the need of surgical experience in addition to the inevitable prolongation of the operation time and the need of interpretation by an experienced radiologist have made its use more difficult.…”