COMMON BILE-DUCT INJURY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Bile duct injury can occur more frequently during laparoscopic cholecy stectomy than in open cholecystectomy. Three eases of common bile or h epatic duct injuries occurred in a series of eighty laparoscopic chole cystectomies; In case 1, the common bile duct was misidentified as the cystic duct. In case 2, bile peritonitis occurred on the fourth posto perative day caused by necrosis of the common hepatic duct involving t he cautery surrounding it. In case 3, a bile leak occurred due to an i ncision at the confluence of the cystic and common duct. Dissection of the cystic duct at the infundibulm of the gallbladder, blunt dissecti on of the Calot's triangle, the handling of clips with special attenti on for safety were thought to be necessary in order to lower the risk of bile duct injury. Preoperative endoscopic retrograde cholangiograph y (ERCP) is recommended to avoid bile duct injury.