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Uruguayan Medical Journal

ISSN: 1688-0390


Vol.15 - Nº 3 - Dic. 1999

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Prophylaxis of iatrogenic lesion in the main biliary tube: "seemingly easy" surgical aanatomy in the cholecystectomy

GILARDONI-CHEDUBEAU F
Rev Med Urug 1999; 15: 193-198
Full text (spanish) |  Full text (spanish) (New windows, pdf) | Abstract

Abstract

Cholecystectomy, an important surgery, is associated with high rates of iatrogenic injuries of the biliary tree.

Frequently, these injuries are unnoticed and surgical procedures are mistakenly described as ?easy surgeries? that could lead to potentially lamentable consequences. This topic has been issued in medical literature for the last decades We reviewed the main articles since the first observations were published (Walton, 1939, 1944)

We include the analysis of three observations from our cases. The intention is to show the most frequent mista- kes made while doing cholecystectomy, and the ways to prevent them.

These three cases had ábnormal anatomical biliary tree disposition, of tricky appeatance, that led to confusion during cholecystectomy, surgical accidents in two cases and in the third a potential accident was prevented following a careful observation. In those cases common duct was mobile and very thin, but close to confluente area it was fixed and hidden under Hartmann?s pouch. Gallblader traction separates -unnoticed by the surgeon- the common duct from the hepatic pedicle creating an abnormal site where the hepatic duct occupied cystic artery site and the common duct took cystic duct site. In al1 patients, biliary tracts were repaired without incidents.

Conclusions Director retrogressive cholecystectomy could be dangerous if cysticcommon ducts confluente has not been previously identified. Entering in a different site could lead to virtually important surgical accidents.