[Pedicular traumas during laparoscopic cholecystectomy. Apropos of 5 cases]. / Les traumatismes pédiculaires de la cholécystectomie laparoscopique. A propos de cinq cas.

Laparoscopic cholecystectomy is now the procedure of choice for surgical removal of the gallbladder. Injury to the hepatic pedicle is the most significant complication of this procedure. Four cases of bile duct injury and one case of right hepatic artery injury were reviewed. Two complications arose from excessive use of cautery in the area of bile common duct and right hepatic artery, resulting in one case of biliary necrosis and one case of right hepatic artery pseudoaneurysm. Two injuries were due to classical confusion between the common bile duct and the cystic duct. Another injury was due to partial ligation of the common by a clip on the cystic duct. Two patients required a Roux en Y hepaticojejunostomy, two patients had a common duct repair on a T tube and one patient required emergency ligation of the right hepatic artery and suture of the duodenum. We did not observe any mortality. Morbidity consisted of one case of spontaneously resolving duodenum leakage. In the light of these cases, after having discussed the therapeutic attitudes toward these lesions. The authors suggest practical tips to prevent hepatic pedicle injuries during laparoscopic cholecystectomy.

[Hydatid cyst of the pancreas. Apropos of 2 cases]. / Kyste hydatique du pancréas. A propos de deux observations.

Two new cases of pancreatic hydatidosis are reported. The diagnosis of a cystic lesion of the pancreas has been easily established owing to the modern imaging techniques, especially to computed tomography. The hydatid nature has also been recognized before surgery on the basis of the epidemiological data, the existence of a calcified shell in one case, and positive serology in the other. Retrograde endoscopic cholangiowirsungography allowed specifying the relationships between the cyst and the pancreatic duct in one case. The treatment consisted in the resection of the protruding dome and in total cystectomy. There were no postoperative complications. The preoperative diagnosis of the lesion must no longer be regarded as difficult. The treatment does not raise any specific difficulties when there is no fistula into the pancreatic duct. Retrograde endoscopic cholangiowirsungography is a good means of recognizing a possible fistula and makes a scheduled surgical treatment possible.