Sound criteria

Gallstone disease is one of the most common surgical diseases of abdominal organs and is according to domestic and foreign authors, from 14 to 17% [1,2]. Since 1990, the increased incidence of injuries and strictures of the bile ducts associated with the expansion of the proportion of laparoscopic cholecystectomy [3,4]. For example, if the frequency of iatrogenic bile duct injury has been stable in recent decades and was 0,05-0,2%, then the application of laparoscopic cholecystectomy, it has grown to 0,3 - 3% [5,6]. Prevention, diagnosis and treatment of iatrogenic injuries of the hepatobiliary zone during laparoscopic cholecystectomy are far from the final decision remains high, and postoperative mortality in the treatment of these patients.

Among the complications that arise in the surgical treatment of cholelithiasis in our clinic, iatrogenic injuries of bile ducts, major blood vessels and hollow organs are rare and constitute 1.2% of all patients operated on laparoscopically. At the same time, it is the most severe cases of the nature of damages, moral and material losses.

It is believed that the main difficulties in treating patients with iatrogenic injuries - reconstructive surgery. But this is not the first nor the only difficulty. First, despite a small in absolute terms the number of these complications, they are nevertheless growing. Secondly, the tactics of treatment of patients at different periods from the time of the occurrence of complications is different and requires the provision of skilled care. Thirdly, this type of complications occur more frequently during the development of laparoscopic cholecystectomy as well as on the periphery, where surgeons work with limited experience of reconstructive surgeries at the biliary system.

The aim of our study was to study the features of iatrogenic injuries in the LCE, and their influence on the choice of tactics and methods of surgical correction.

Materials and methods

In the department of surgery of the digestive system of the Institute of Gastroenterology of Medical Sciences of Ukraine from 1993 to 2003. performed 4627 operations for calculous cholecystitis, including laparoscopic cholecystectomy - 3864 (83,5%). The proportion of laparoscopic cholecystectomy was 93.2%, while in calculous cholecystitis with chronic inflammation has 95,2% of operations and the operations performed on the calculous cholecystitis with acute inflammation was 4.8%. The results of treatment of 46 patients. with iatrogenic injury during laparoscopic cholecystectomy. 81.5% of patients were women, 18,5 - men. Age of patients ranged from 26 to 67 years and averaged 44 years.

Surgical tactics in each case determined by the type of damage and the time elapsed from the moment of its recognition.

Analyzing the reasons that contributed to the occurrence of iatrogenic injury during laparoscopic cholecystectomy, we identify clinical and anatomical features, the lack of individual skill and experience of the surgeon, the technical conditions of operation. Thus, the atypical location of the vascular-duct elements in the area of the gallbladder, in our observations were noted in 9 patients (19,6%), expressed in commissural and inflammatory infiltrative changes гепатопанкреатодуоденальной zone have caused damage - in 27 patients (58,7%) , underqualification surgery that is usually associated with the period of the development of a method or rare (<4 times per month) executing operations - contributed to the occurrence of iatrogenic injuries in 8 patients (17,4%), and finally equipment failure was the occasion to complications 2 patients (4.3%).

In the structure of trauma injuries duct brand viagra system was 71.7% (33 patients), vascular damage - 23.9% (11 patients), damaging the surrounding organs - 4,3% (2 patients: 12n-colon - 1 patient, the diaphragm - 1 patient).

The absence of sound criteria for selecting method of surgical correction is more than just damage to the bile ducts as often in the treatment of similar injuries and apply restorative and reconstructive surgery, as well as different ways to frame drainage.

Injury, recognized during laparoscopic surgery are subject to immediate removal. If the reason was zhelcheistecheniya small extra bile duct in the bed of the gall bladder and recognized complication during surgery, the latter are stitched or clipped, and the ductal system drenirovalyas through the stump of cystic duct.

hormones
use medications
careful monitoring
inhibitory effects
myocardial infarction