Non-image diagnosis of bile duct injury during laparoscopic cholecystectomy.

OBJECTIVE

To evaluate the role of simple non-image technique in intraoperative diagnosis of bile duct injury (BDI).

METHODS

BDI was highly suspected at the original laparoscopic cholecystectomy (LC) when the following 3 abnormal findings were noted: the "cystic duct" stump (the common bile duct stump actually) markedly retracted down to the duodenum; bile leakage from the porta hepatis; abnormal mucosal patch attached to the "cystic duct" stump of the removed gallbladder. All cases of suspected BDI were converted to have laparotomy. image techniques such as intraoperative cholangiography or ultrasonography were not utilized for recognition of BDI in all 9 patients.

RESULTS

BDI in 4 of the 9 patients was suspected according to 1-3 abnormal intraoperative findings described above. The four patients were subjected immediately to converted laparotomy. Abnormal findings were not observed or misinterpreted in the other 5 misdiagnosed patients.

CONCLUSIONS

Timely recognizing whether BDI occurs should be considered as a routine procedure of LC. Negligence of operators to the abnormalities of the original LC is the main cause of misdiagnosis for BDI. Simple non-Image approaches such as close observation of these abnormalities can make timely diagnosis for most BDIs during the original LC.