Non-standard situations in surgical practice as a cause of iatrogenic injuries of the bile tract
DOI:
https://doi.org/10.11603/2414-4533.2017.3.8119Keywords:
gallstone disease, iatrogenic injury of bile tract, conversion.Abstract
The aim of the work: to generalize the experience of using laparoscopic interventions in patients with urgent and planned surgical pathology and to prevent probable complications.
Materials and Methods. In the work, a retrospective analysis of the results of laparoscopic interventions in 8245 patients with gallstone disease (chronic cholecystitis – 4905 patients, gallbladder polyposis – 33 patients, acute cholecystitis – 3307 patients) has been carried out.
Results and Discussion. Damage to the bubble duct or choledoch duct occurred in 19 patients (Mirrizi syndrome occurred in 13 patients). The localization of lesions was as follows: total bile duct (I type according to H. Bismuth) – in 8 patients, total liver duct (II type according to H. Bismuth) – in 6 patients, total bile duct along with bifurcation (III type according to H. Bismuth ) – in 4 patients, the total bile duct with damage to the confluence (IV type according to H. Bismuth) – in 1 patient. In 5 patients, iatrogenic damage to the biliary tract was detected during the operation, and in 14 patients – in the early postoperative period. All this led to the solution of extremely difficult and complex problems in the future, since the sequence of use of diagnostic techniques is not the same for all patients. It should be noted that more satisfactory results were then when iatrogenic damage to the biliary tract was detected sub-operatively. In a situation where it is not possible to conduct a standard laparoscopic cholecystectomy there are various complications. Timely conversion is an extremely important moment in preventing injuries to the bile ducts in technically difficult cases, and recovery of bile outflow can be achieved only when an experienced specialist who has methods of restorative and reconstructive surgery is included in the operating team.
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