Content area
Full Text
Abstract
The dissection of the cystic pedicle represents the "main" issue in performing the cholecystectomy, as well as the surgical moment when many accidents may happen. The paper analyzes the most frequent causes, which can generate iatrogenic injuries of the common bile duct (CBD) during the dissection of the cystic pedicle, such as the ductal and vascular anatomical variants, the local pathological transformation, human errors, etc.
Keywords: common bile duct iatrogenic injuries, laparoscopic cholecystectomy
The iatrogenic injuries of the common bile duct (CBD) are rare but have a great postoperatory morbidity and mortality potential. This has generated many studies and complex analyses, which have shown that many of these serious intraoperatory accidents can be avoided. The surgeon is the person who has the entire responsibility of the surgery and he has to know very well the technical aspects of the surgical intervention, but he also has to have a thorough clinical and operatory experience in order to assure the total safety of the patient during laparoscopic cholecystectomy [1].
The "main" issue in performing the cholecystectomy is represented by the dissection of the cystic pedicle. It is not the only moment when CBD iatrogenic injuries can occur, but it is also the surgical moment when many accidents may happen.
A thorough analysis of the causes that can generate CBD iatrogenic injuries during the dissection of the cystic pedicle, has shown that they are driven by the following:
* ductal and vascular anatomical variants which hampers the correct identification of the structures [2]
* pathological transformation or difficult surgical conditions, which modify topography and hamper the orientation and dissection [3]
* human errors, when the surgeon has overestimated the limits of the surgery or the personal ones [4].
Anatomical variants of the extrahepatic biliary ducts and the afferent vessels are more frequent than the "normal" descriptions presented in the classical anatomy treaties. Among the multitude of ductal and vascular variants, only about 10-15% have a technical surgical importance.
The anatomoclinical studies have shown that these deviations from the normal anatomy, both of the vessels and of the biliary ducts are more frequent in patients with biliary lithiasis [2].
Due to the fact that the safety of the surgery depends on a correct anatomical and topographical...