[Iatrogenic injuries of bile ducts during cholecystectomy]

Having analyzed case histories 266 patients with cicatrical strictures of bile ducts, due to iatrogenic trauma in cholecystectomy who were admitted to clinic for reconstructive operation, the authors established that in 53% of patients the injury of bile ducts was not revealed during the operation. In missed bile ducts injury there were 5 varieties of clinical manifestations in the early postoperative period: 1) mechanical jaundice (72 patients); 2) exterior bile leakage (33 patients); 3) diffuse biliary peritonitis (23 patients); 4) mechanical jaundice and exterior bile leakage (5 patients); 5) mechanical jaundice and subhepatic abscess formation (6 patients). From 117 patients in whom iatrogenic trauma of the biliary tract was revealed in cholecystectomy, in 55 biliobiliary anastomosis was carried out, in 40--biliodigestive anastomosis in 22-external drainage procedure of biliary tract was accomplished. In the recent iatrogenic trauma of biliary ducts the authors have operated on urgently 12 patients, in 5 of which reconstructive operations were carried out (in 2--with removal transhepatic drainage, in 3--with T-shaped drainage) and in 7 patients--precisional biliointestinal anastomosis without framed drainage. In all the patients after reconstructive operation with T-shaped drainage in long-term period cicatricial stricture of hepaticocholedochus has developed. Favourable result was observed in patients after reconstructive operation with changeable transhepatic drainage and in patients with precisional biliointestinal anastomosis. The last variant of correction of the iatrogenic bile ducts T injuries is the most preferable. The external drainage procedure of bile ducts should be used when there are no suitable conditions for accomplishment of reconstructive surgery.