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  • Vloga laparoskopske operativne metode "okna" pri preprečevanju poškodb žolčevodov med holecistektomijo = The role of "window" laparoscopic operative technique in the prevention of bile duct injuries associated with cholecystectomy
    Benedik, Tomaž ; Vračko, Jože
    Laparoscopic cholecystectomy has rapidly become well-established because it prvides ultimate cure of gallstone disease with minimal pain and loss of activity for the patient. However, the incidence ... of biliary tract injuries, which are potentially life-threatening and associated with major morbidity andprolonged hospitalization, appears to be higher during laparoscopic cholecystectomy than during open surgery. As reported in some studies the rateof bile duct injuries associated with the laparaoscopic technique is 2.5 to 4 times higher than with open cholecystectomy. Several classifications of biliary tract injuries have been proposed. The most frequent direct causes of laparoscopic biliary tract injury include: misidentification of the common bile duct, cautery-related injuries of the bile duct and improper application of clips to the cystic duct. Accurate identification of the cystic duct and cystic artery before their being divided is therefore of utmost imporance in every laparoscopic cystectomy. Calot's triangle should therefore be dissected free of fat and fibrous tissue, and the lower end of the gallbladder should beseparated from the liver bed to provide optimal visualization of the only two structures entering the gallbladder - the cystic duct and the cystic artery. Blind use of cautery and clips to control bleeding should be avoided.Low cautery settings should be used in portal dissections to prevent arc. The rate of bile duct injuries associated with laparoscopic cystectomy - which is still intolerably high- can be minimized by meticulous dissection andaccurate identification of the cystic duct and cystic artery.
    Vir: Endoskopska revija : glasilo Sekcije za endoskopsko kirurgijo in Sekcije za gastroenterološko endoskopijo Slovenije = Endoscopic review : journal of Slovenian Society of Endoscopic Surgery and Society of Gastroenterologic Endoscopy. - ISSN 1318-8941 (Letn. 5, št. 11, apr. 2000, str. 35-41)
    Vrsta gradiva - članek, sestavni del
    Leto - 2000
    Jezik - slovenski
    COBISS.SI-ID - 11797209

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