Diagnosis and management of biliary complications of laparoscopic cholecystectomy

Symptomatic outcome following laparoscopic cholecystectomy

“…Post cholecystectomydiarrhoea was reported by 11% of the patients.A similar incidence has been reported previously 4 . Loose stools, with relapsing bouts of more abundant watery diarrhoea after removal of the gall bladdercan be explained by postoperative disturbance of bile metabolism and changes in the dynamics of bile release resulting in subclinical fat malabsorption 5 .…”

“…In this study, seven patients developed this symptom for the first time after cholecystectomy. Although this may be because of a change in patients' dietary habits after cholecystectomy, there is evidence that the higher oesophageal acid exposure in patients with cholelithiasis may be aggravated by cholecystectomy as a result of a fall in the lower oesophageal sphincter pressure 4 .The results of this symptomatic survey do not confirm this reported finding as symptomatic relief of heartburn by cholecystectomy outweighed its de novo occurrence postoperatively.…”

“…Jaundice after cholecystectomy was not encountered in this study. However,literature revealed that an incidence of retained or missed common bile duct stones of 1% or less 3,4 . Wound healing problems were reported by 9%.This low infection rate relates to the state of the wound during the hospital period and ignores wound problems that are experienced by 60% of patients after discharge from hospital.…”

Management and prevention of iatrogenic bile duct injury

“…The most common mechanism is the so called 'Classic Injury'. This occurs when the operator misidentifies between the cystic duct and the common bile duct during the dissection of Calot's triangle (23,24,25,26). The bile duct is inadvertently transected and common hepatic duct is dissected upwards up to the hilum.…”

Managing bile duct injuries sustained during cholecystectomies

“…1 Injuries caused are both major and minor in nature. 2 Clip slip, clip application in confusion, laparoscopic environment, inadequate biliary defaults, video view illusion added to the causation. 3 The bile duct injuries in laparoscopic cholecystectomy are more active than passive in nature.…”