Uncommon left hepatic duct injury during laparoscopic cholecystectomy

Laparoscopic cholecystectomy is currently the gold standard in the treatmen t of symptomatic gallstones but has been shown to have a higher incidence o f biliary tree lesions (0.3-1%) compared with reported traditional open app roaches. Loss of three-dimensional view and of depth perception is the main limit of the laparoscopic approach, especially if particular risk factors are associated (e.g., postinflammatory fibrosis, anatomic variations). More over, inadequate training may justify the increase of biliary tract lesions . The authors describe a unique case of left hepatic duct clipped without s ection of the duct itself during an otherwise "easy" operation. At the rein tervention, because of the favorable local condition, a reconstruction was possible after a small duct resection with a ductal-hepatic anastomosis ove r a T-tube. This was removed after 8 months because of the good patency of the biliary tree and the absence of cholestasys. A long-term follow-up is m andatory for a complete functional evaluation.