Background: The safety of laparoscopic cholecystectomy sometimes compromised by the rare complication of major bile duct injury, with a devastating sequel of higher mortality and morbidity. Many factors can lead to the occasional insultonslaught of visual misinterpretation of the ductal anatomy.
Methods: From October 2005 to June 2016, 2240 patients were subjected to laparoscopic cholecystectomy. In 985 patients, a step of fundal and infundibular traction release, before attempting any clip application, was added to the technique , its role in minimizing the incidence of major bile duct injury was assessed, and compared to 1255 patients in whom the new step was not adopted.
Results : The overall conversion rate to open surgery was 5.1%. No single major bile duct injury was documented in the study group, as compared to 8eight patients in the control group. The visual documentation of tenting in the common bile duct, from lateral gall bladder traction, appeared to be protective against bile duct injury.
Conclusion: Traction release may realign the traction induced distorted bile duct structure, and hence may minimize the risk of bile duct injury.