[Pedicular traumas during laparoscopic cholecystectomy. Apropos of 5 cases]

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.