IATROGENIC INJURIES OF THE COMMON BILE DUCT AND THERAPEUTIC MANAGEMENT. REPORT OF 5 REPRESENTATIVE CASES AND REVIEW OF THE LITERATURE

Abstract

Objective: To review the therapeutic, depending on the type of injury management, location according to the classification of Strasberg's - Bismuth, and according to the moment in which the diagnosis is made. Methods: Five cases with iatrogenic injuries of the biliary tract,
of 411 cholecystectomies in the Hospital José María Benítez since January 2008 to October 2013, which was carried out surgical or
endoscopic treatment according to the case are presented. It’s a descriptive and retrospective study. Results: Of the 5 patients presented, 4 belong to the Hospital José María Benítez and one was referred to other health care, total 411 cholecystectomies: open 310, laparoscopic 101. The incidence in open cholecystectomy 0.97% (3/309) and laparoscopic 0.99% (1/101). The resolution was carried out in 4 cases with surgical treatment and in 1 case with endoscopic treatment, sphincterotomy plus biliary stent. Postoperative evolution was without complications.
Conclusion: The main bile duct iatrogenic injuries are complex clinical situations with significant morbidity, generating acute or chronic complications, severely affecting the quality of life in the best of cases, the vast majority occur during cholecystectomies and it is considered to be the result of an incorrect identification of the elements of Calot’s triangle. Once presented, requires a comprehensive approach and a trained multidisciplinary team between surgeons, radiologists, and endoscopists.