Diameter

It should be noted that zhelcheistechenie in the first postoperative day up to 200 ml of 95% of patients, according to the performed ERCP was not associated with damage of the main bile duct and ended on its own within 7-10 days without any long-term complications. If you have any zhelcheistecheniya for the control of drainage in the first 2-3 days after the operation for more than 200 ml, the patients underwent abdominal ultrasonography, ERCP, and if necessary, laparoscopic sanitation of the abdominal cavity with drainage zatekov, and then decompressed biliary tract using nazobilliarnogo drainage or endoscopic papillotomy.

For 10 years the clinic indicated tactic was used in 16 patients. The result is good, were no deaths.

Another tactic is used in wound trunk channels. If the duct injury is not more than half the diameter, wound closure was performed with the installation of a frame (T-) drainage, the knee is performed above or below the level of injury. Carcass was left for drainage for up to 6 months. Four of these patients were examined within 3 years after surgery. Long-term results are satisfactory.

Complete intersection of the main duct or excision of part of it for 10 years in our clinic was noted in 13 patients. In the acute phase in 5 patients produced gepatikoeyunostomiyu on transhepatic external drainage, which were removed after several substitutions, only two years later. In 4 patients underwent bilio-bilioanastomozy end to end with no substructure drainage with the use of precision equipment. In one case developed anastomotic stricture and required a second operation. In four cases made staple the ends of transected gepatikoholedoha on the T-shaped drainage, which was further reinforced polypropylene net, fixed in a box, above and below the intersection. Drains removed after 6 months, long-term results are satisfactory.

It should be noted that 17.4% of patients damaged duct system were not detected during a second operation. Encountered in postoperative biliary complications (zhelcheistechenie on drainage and drainage by a bandage, jaundice, diffuse biliary peritonitis) require serious thought-out action programs to the formulation of specific algorithms for each type of damage. Often - is a two-step tactic, the first stage of which - the struggle with peritonitis (detoxification, forced sanifying operation with external diverting bile) and reconstructive intervention after stabilization of the patients on the second stage.

No less formidable and serious complication was a wound to major vessels: the hepatic artery, portal vein or hepatic veins. With such complications, we brand viagra met in 11 patients. For unusual variations of blood supply increases the risk of vascular injury and of bleeding, which in turn can lead to injury of the ducts in the implementation of hemostasis [7].

In all cases, a laparotomy was performed and produced by ligation of the branches of the hepatic artery in 8 patients with 2 - completed joint portal vein. In one case, was traumatized by a major branch of right hepatic vein, which closely approached the bed of the gallbladder, its flashing did not lead to a complete stop bleeding. In this case, the patient died of continuous bleeding.

Injuries to adjacent organs, the result of electrosurgical injury during laparoscopic cholecystectomy (diaphragm injury, injury to the wall 12n-gut) gave rise to the conversion in 2 cases. In the first case holds suture of the diaphragm with drainage of the pleural cavity, the second - wound closure of the duodenum with the imposition of retrocolic anastomosis and conduct a probe for food. Mortality rate was 2,1%

Conclusions:

For the prevention and treatment of iatrogenic injuries of the zone of surgery for laparoscopic cholecystectomy is required well-designed programs of action, including assessing the causes or risk factors for possible complications and application of sound tactics when choosing a method of surgical correction.

sympathetic activation
many years
choice for correction
wrong interpretation
long time