Strasberg et al classified injuries to the biliary tract that can occur during laparoscopic cholecystectomy. The authors are from Washington University in St. Louis.


Major classes of injury:

(1) misidentification of a bile duct

(2) technical errors


Common problems with identification of a bile duct:

(1) common bile duct misidentified as the cystic duct

(2) aberrant right bile duct misidentified as the cystic duct


Technical errors - injudicious behaviors:

(1) excessive (or misdirected) use of thermal energy (to control bleeding, dissect or divide tissue)

(2) use of vascular clips trying to control bleeding


Technical error - poor technique:

(1) improper ductal exploration

(2) plane of dissection on the liver bed too deep


Technical error - tying off:

(1) cystic duct not securely occluded

(2) tenting injury of the common bile duct (common bile duct is pulled up and caught in the clip or ligature placed on the cystic duct)


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