Laparoscopic Gall Bladder Surgery and Bile Duct Injury

Karen Gatlin

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Bile duct injury is a risk of laparoscopic gall bladder surgery; however, the risk of injury can be minimized if the surgeon follows accepted standards of surgical procedure. A patient with acute choleycystitis is at an increased risk of bile duct injury during surgery; therefore, an intra operative cholangiogram should be performed in every case because it helps clarify anatomy. Similarly, an obese patient is also at increased risk as is a patient whose ultrasound shows a thickened gall bladder.

During surgery, the surgeon must identify the common bile duct as well as other anatomical structures such as the Triangle of Calot which is comprised of the cystic artery, cystic duct and common bile duct. The surgeon must start at Hartmann's pouch and dissect toward the cystic duct which may be hidden in the presence of inflammation. Once the cystic duct, common bile duct and cystic artery have been identified and dissected free of each other, it is safe to ligate and divide the cystic duct and cystic artery. Conversion to an open procedure from laparoscopic surgery should be done whenever there is any question concerning anatomy.