J Minim Access Surg 11:113–118, Gurusamy KS, Koti R, Davidson BR (2013) Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Late complications of bile duct injury are biliary cirrhosis, portal hypertension and it is complications ending in liver failure. Nowadays, safety concerns during the immediate postoperative period are minor, since most surgical clips are made of non-ferromagnetic material. a–d On the 5th postoperative day, MRCP (a) showed usual postoperative collection at gallbladder fossa (*), dilated intrahepatic ducts and proximal CBD with abrupt termination (arrow) and normal choledochus distally to the discontinuity. Within the first postoperative week, minimal fluid or blood (Fig. Eur Radiol 9:1407–1410, Watanabe Y, Nagayama M, Okumura A et al (2007) MR imaging of acute biliary disorders. Emphasis is placed on CT as the “workhorse” modality, on the role of MRI with magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive, combined anatomic and functional assessment of the operated biliary tract [10,11,12,13,14]. Similarly to the preoperative setting, MRI with MRCP sequences is the best modality to visualise the operated biliary tract and has a crucial role to evaluate suspected iatrogenic biliary injuries, unless contraindicated by claustrophobia, cardiac pacemaker or other MRI-unsafe device. A steel oxygen tank is never permitted inside of the MRI system room. MRCP reliably detects intrabiliary filling defects, even in non-dilated CBD (Fig. Conversely, nowadays, ERCP and biliary stenting (Fig. 4. 3) should be evaluated for the presence of haematoma, signs of infection and herniation [25, 26]. Similarly to biliary obstruction, bile leakage develops most commonly after laparoscopic cholecystectomy (incidence 0.4–1%) than open cholecystectomy (0.1–0.5%), and is categorised as major in 28–40% of cases. Specifically, some surgeons tried to decrease the size and number of ports to improve cosmetic and postoperative outcomes, until the most recent development represented by the single-site laparoscopic cholecystectomy. 4 Biliary anatomical variations can lead to perioperative misinterpretation and are a risk factor for bile … 17) is a typical sequela of laparo-endoscopic rendezvous cholecystectomy [38]. A retrospective analysis of 10,174 laparoscopic cholecystectomies. 6) and by haemostatic agents such as Surgicel™ (oxidised regenerated cellulose), which appear as complex collections with 40–50 HU attenuation and intermixed gaseous foci [10,11,12,13,14]. Surg Laparosc Endosc Percutan Tech 25:97–99, Ansaloni L, Pisano M, Coccolini F et al (2016) 2016 WSES guidelines on acute calculous cholecystitis. 16). Compared to MRCP, the sensitivity of CT for gallstones is much lower and requires focused review (Fig. Over the years, the laparoscopic technique underwent modifications. Postcholecystectomy clip migration was first described in the literature in 1978. 15), inadvertent CBD clipping, thermal injury and extrinsic compression by an abnormal collection [27, 28]. Cholecystectomy accomplished for benign stone disease should not create a ‘biliary cripple’ patient. Using focused reconstructions, CT (Fig. The patient was treated by positioning of percutaneous drainage, Atypical sites of post-cholecystectomy bleeding. e, f On the 12th postoperative day, CT (e) showed ascites, fluid collection in the surgical bed (*) and a CBD stricture (arrow) attributed to probable thermal injury, which was treated endoscopically with the positioning of a stent (thick arrow in post-procedural CT, f). Before laparoscopic cholecystectomy, patients should be stratified according to the risk of coexistent common bile duct (CBD) lithiasis. Cir Esp 95:465–470, Nuzzo G, Giuliante F, Giovannini I et al (2008) Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. The risk is highest when MRCP has not been obtained before laparoscopic cholecystectomy. They are used to clip the artery going to the gall bladder and the duct that drains the gall bladder. 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