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Minerva Chirurgica 2002 October;57(5):663-8

language: English

Analysis of pathogenetic mechanisms of common bile duct iatrogenic lesion during laparoscopic cholecystectomy. A review of the literature

Schiano di Visconte M.


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Background. Laparoscopic cholecystectomy as the new gold standard for gallstone treatment has reopened the chapter of complications due to cholecystectomy.
Methods. The present work refers to the period between 1988-2001 and analyses 277,121 cholecystectomies, carried out in some European and extra-European Countries. 1,353 CBD lesions with an incidence rate of 0.48%, that almost doubles that of the laparotomic cholecystectomies, were found. Transection of CBD within <2 cm of bifurcation was the most frequent lesion.
Results. The mechanism and extension of CBD lesions is different when compared to that of laparotomic intervention. Actual damage is caused by a failure to recognise the anatomical structures, and also by errors in the surgical technique, learning curve and different visua-lisation of the operative field.
Conclusions. Once the lesion has been diagnosed it is always necessary to define its type and extension accurately. A therapeutic approach that fails to take this aspect into account will expose the patient to repeated and increasingly complex surgical interventions, recurrent cholangitis episodes and a higher risk of suffering a secondary biliary cirrhosis.

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