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A Journal on Surgery

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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.


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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