BILE DUCT INJURIES IN DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

LAPAROSCOPIC CHOLECYSTECTOMY HAS QUICKLY BEC OME THE OPTIMAL THERAPEUTICAL OPTION IN THE CASE OF GALLBLADDER LITHIASIS BECAUSE OF HIS MINIMALLY INVASIVE TECHNIQUE, REDUCED POSTOPERATIVE PAIN, FASTER RECOVERY, SHORTER HOSPITALIZATION, AND AS A WHOLE, REDUCTION OF THE HOSPITALIZATION COSTS. WE STUDIED 3595 CASES OF LAPAROSCOPIC CHOLECYSTECTOMIES PERFORMED IN THE 4TH GENERAL SURGERY CLINIC IN CRAIOVA BETWEEN 2001 AND 2015. OF THESE, IN THIS ARTICLE, WE DISCUSS CASES OF EXTRAHEPATIC BILE DUCTS INJURIES PRODUCED DURING LAPAROSCOPIC CHOLECYSTECTOMY. WE EXCLUDED FROM THE STUDY THE LESIONS PRODUCED DURING CLASSICAL CHOLECYSTECTOMY OR OTHER SURGICAL INTERVENTIONS INVOLVING ADJACENT ORGANS. IN THE FOLLOWING, WE PRESENT THE CAUSE OF THESE LESIONS, THE MOMENT OF RECOGNITION AND OUR WAY OF SOLVING THESE LESIONS. WE FOUND TWO LESIONS FROM A TYPE OF STRASBERG CLASSIFICATION, FIVE PUNCTUAL OR PARTIAL INJURIES (D TYPE OF STRASBERG CLASSIFICATION )OF THE EXTRAHEPATIC BILIARY DUCTS AND SIX MAJOR LESIONS ( E TYPE OF THE SAME CLASSIFICATION). IN THE CASE OF MINOR LESIONS, EVEN IF THEY WERE RECOGNIZED POSTOPERATIVELY, LAPAROTOMY SHOULD BE AVOIDED AND ATTENTION SHOULD BE GIVEN TO CORRECT DIAGNOSIS OF THE TYPE OF LESION AND ITS LOCALIZATION THE COMPLETE LESIONS OF THE MAIN BILE DUCT NECESSARILY REQUIRE AN OPEN INTERVENTION, AND THE PROCEDURES USED MAY BE: END -TO-END SUTURE, WHETHER OR NOT PROTECTED BY A TUTOR TUBE OR BILIO-DIGESTIVE DERIVATIONS IF THE MAIN BILE DUCT’S DIAMETER PERMITS US (IF IT IS DILATED). THE USE OF HEPATICOJEJUNOSTOMY ON ROUX-EN-Y LOOP REPRESENTS THE FAVORITE APPROACH IN THE RE-ESTABLISHING OF BILIARY CONTINUITY.

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