XXXX during laparoscopic cholecystectomy -- own material.

@entity1 @entity254 @entity1157 @entity2963 @entity2679 @entity881 @entity360 @entity255
BACKGROUND: Despite recognised advantages of laparoscopy, the damage of extrahepatic bile ducts during cholecystectomy is a subject of ongoing discussions, as such injuries are more frequent comparing with open surgery. MATERIAL/METHODS: The analysis included 6873 @entity1 who underwent laparoscopic cholecystectomy. The study group comprised both the @entity1 after elective surgery due to symptomatic @entity2963 and @entity1 after emergency procedures necessitated by acute @entity2679 . RESULTS: Common bile duct was damaged in 9 @entity1 . Five @entity1 had their main bile duct transected, in 2 @entity1 it was partial excision, and in the other 2 subjects - puncture damage with electrocoagulation took place. In seven cases, the damage was diagnosed still during laparoscopy and conversion to open surgery was performed. In two subjects the damage was diagnosed in postoperative period and it was subsequently confirmed by ERCP. Reconstructive surgery included: CBD suturing with interrupted stitches, end-to-end @entity254 over T-tube and Roux-en-Y bilioenteric @entity254 . Good postoperative outcome was obtained in 6 @entity1 . One subject required repeated endoscopic dilatation and placement due to recurrent @entity255 . Two @entity1 died due to upper @entity360 and @entity881 . CONCLUSIONS: @entity1157 remains a dangerous complication following cholecystectomy. It is more likely to occur in case of anomalous anatomy of bile ducts, inflammatory or malignant infiltration and technical errors of an operating surgeon. It is very important to diagnose the damage early enough, preferably still during laparoscopy. Imaging investigations (ultrasound, ERCP, MRCP, cholangiography) may be helpful in establishing the diagnosis during the postoperative period.
