[Common bile duct injuries during videolaparocholecystectomy]. / Le lesioni della via biliare principale in corso di videolaparocolecistectomia.

ABSTRACT

In the years an increase of last biliary injuries during laparoscopic cholecystectomy was observed. At present this occurrence rate is 0.1-3.4% of laparoscopic procedures. Probably this is to be related to less contraindications to cholecystectomy by laparoscopic procedures, with increase of more difficult operations. The intraoperative biliary injuries are due to anatomical anomalies of the local structures, mistakes of technique, flogosis of the cholecisto-choledocal region. Factors preventing iatrogenic injuries are accurate and standardized operative technique, adoption of modern instruments, intraoperative cholangiography. The Authors have reviewed their experience based on 1236 laparoscopic cholecysectomies performed in six years (1992-1998) in their own structure. Four lesions of the biliary tract (0.3%) have occurred three Bismuth I-II and one Bismuth IV. They have always performed intraoperative cholangiography, without false negative, in contrast with present literature. They conclude underlining the need of the routine contrastrographic study of the biliary tract in all cholecysectomies as well as of an adequate training in radiological imagines interpretation.