LESIONS OF THE COMMON BILE-DUCT AT CHOLECYSTECTOMY

The incidence of bile duct injuries during open cholecystectomy is around 2parts per thousand. The most common lesion is complete divisions of the common bile duct, followed by partial divisions, stenoses or obstructions. The therapy of the lesions recognized intraoperatively is end-to-end anastomosis or, in the case of greater defects, hepaticojejunostomy. Strictures manifesting while after cholecystectomy can primarily be treated endoscopically, in divisions of obstructions hepaticojejunostomy is indicated; in high lesions the Hepp-Couinaud approach can be advocated.