biliary complications post laparoscopic cholecystectomy mechanism, preventive measures, and approach to management a review腹腔镜胆囊切除术后胆道并发症机制、预防措施和管理方法审查.pdfVIP

Hindawi Publishing Corporation Diagnostic and Therapeutic Endoscopy Volume 2011, Article ID 967017, 9 pages doi:10.1155/2011/967017 Review Article Biliary Complications Post Laparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review Norman Oneil Machado Department of Surgery, Sultan Qaboos University Hospital, P.O. Box 38, Muscat 123, Oman Correspondence should be addressed to Norman Oneil Machado, oneilnorman@ Received 15 February 2011; Accepted 8 April 2011 Academic Editor: Daniel M. Herron Copyright © 2011 Norman Oneil Machado. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30◦ scope, adequate delineation of structures in Calot’s triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic dra