Background Iatrogenic injury to the bile ducts is the most feared

Background Iatrogenic injury to the bile ducts is the most feared complication of cholecystectomy and several are the possibilities to occur. 320 (62.1 %) by laparotomy cholecystectomy and CX-5461 supplier 195 by laparoscopic approach. The age of patients with bile duct injury ranged from 29-70 years. Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25 %25 %) with lesions, corresponding to 0.77 % of the total patients. No patient had iatrogenic interventions with laparoscopic surgery. Conclusion Laparoscopic cholecystectomy compared to laparotomy, had a lower rate of bile duct injury. Keywords: Cholecystectomy, Cholecystectomy, laparoscopic, Bile duct Abstract Racional A les?o iatrognica das vias biliares representa a complica??o mais temida na colecistectomia e vrios s?o seus fatores desencadeantes. Objetivos Estudar comparativamente os casos de les?es iatrognicas de vias biliares ocorridas em colecistectomias convencionais e videolaparoscpicas, avaliando os provveis fatores causais, complica??es e o seguimento psoperatrio. Mtodo Estudo de coorte retrospectiva, com CX-5461 supplier anlise de pronturios dos pacientes submetidos colecistectomias convencionais e videolaparoscpicas. Foram analisados todos os pacientes operados no perodo de dois anos. O critrio de inclus?o MADH3 nico foi o de existir les?o operatria da via biliar, independentemente de sua localiza??o ou tempo de diagnstico. N?o houve critrios de exclus?o. Foram analisados dados epidemiolgicos dos pacientes, tempo de diagnstico da les?o e sua localiza??o. Resultados Total de 515 pacientes portadores CX-5461 supplier de litase biliar foi operado, senod 320 (62,1%) por colecistectomia laparot?mica e 195 por videolaparoscpica. A idade dos pacientes com les?o de via biliar variou de 29-70 anos. Entre os submetidos colecistectomia laparot?mica, foram diagnosticados quatro casos (1,25%) com les?o de via biliar, correspondendo 0,77% do total de pacientes. Nenhum paciente teve iatrognese com a videocirurgia. Conclus?o A colecistectomia videolaparoscpica, comparativamente colecistectomia laparot?mica, apresentou menor taxa de les?o de via biliar. INTRODUCTION Cholecystectomy began to be held in the late 19th century and was first described in 1882 by Carl Langenbuch. In the 20th century its technical principles were created; major innovations have occurred in the last 25 years with the emergence of videolaparoscopic surgery1,2. Surgical removal of the gallbladder is usually indicated in the treatment CX-5461 supplier of biliary lithiasis and its complications, as well as neoplasms of the gallbladder. Iatrogenic injury to the bile ducts is the most feared complication, with an incidence of around 0.2 to 2.9%3. Factors such as laparoscopy, acute cholecystitis, scleroatrophic gallbladder, anatomic variations of the biliary tract, the curve for new surgeons and residents, are seen as the main causes of the higher incidence of iatrogenic injuries.10 The management of patients with these lesions is very complex, requiring experienced surgeons and mostly specialized services for the treatment of this complication. The prognosis is usually closely related to clinical conditions and the time between the identification of the lesion and surgical treatment5,6,12. Given the learning curve for new surgeons and the presence of a higher incidence of iatrogenic lesions of the bile ducts, the aim of this study was to analyze comparatively the two standard procedures for cholecystectomy – laparotomy and laparoscopy – in order to verify the iatrogenic injuries they may cause. METHODS A retrospective cohort study was performed with analysis of charts of the Department of General Surgery, Hospital Ipiranga UGA – II, S?o Paulo, SP, Brazil. All patients that underwent laparotomic and laparoscopic cholecystectomies from 01/01/2010 to 31/12/2011 were analyzed. The only criterion for inclusion was to be operative bile duct injury, regardless of location or time of diagnosis. There were no exclusion criteria. Information on gender, age, acute or chronic symptoms, type of operation, time of diagnosis of the lesion and its location were evaluated. All patients underwent general anesthesia and operated by residents of the second 12 months of general surgery, guided by assistant surgeons or preceptors. RESULTS A total of 515 patients with cholelithiasis, diagnosed by clinical and imaging examination, were operated being 320 (62.1%) by laparotomy and 195 (37,9%) by laparoscopy. CX-5461 supplier The age of patients with bile duct injury ranged from 29 to 70 years (mean 49.2). Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25.