it is now considered that approximately 10% to 15% of the adult population has gallstones .
age , sex , diet , sudden weight loss , etc . according to the report of the us national institute of health
, it is estimated that 6.3 million men and 14.2 million women , aged 20 - 74 years in the united states has calculosis of the gallbladder , due to which every year is performed about 700,000 cholecystectomy .
male patient , aged about 40 years , admitted at the clinic and laparoscopic surgery was performed in our department for chronic , as multiple , symptomatic gallbladder calculi .
intraoperative findings showed chronically inflamed , curled gall bladder , and wall thickening . after the first postoperative day
there is no content in the drain bag and it is taken out , and the patient leaves the hospital without any problems .
the seventh post - operative day occurred abdominal pain , weakness and fatigue , with striking yellow skin and visible mucous membranes .
clinical , laboratory and echo determined abdomen full of fluids , so it was suspected lesion of the bile duct .
intraoperative was found a lesion of the common bile duct in the form of a complete interruption .
created is anastomosis through transhepatic drain according to pradera . early and late postoperative flow was entirely normal with normal laboratory and echofindings .
control , contrast imaging through a drain showed the orderly flow of extrahepatic bile ducts , with minimal extravasation of contrast .
at the department of surgery of general hospital in konjic laparoscopic cholecystectomy is performed since 1999 . in the beginning
it was done by three trocars ( european style ) , and later , in order to prevent complications or injury of the bile duct is performed surgery with four trocars ( american style ) . the number of complicated procedures in our hospital does not differ from similar indicators in foreign surgical facilities .
the formation of gallstones in the gall bladder is very common ( 1 - 6 ) .
it is now considered that approximately 10% to 15% of the adult population has gallstones .
etiologies are various and include : age , sex , diet , sudden weight loss , etc .
sometimes the pain spreads to the back and can last from several minutes to several hours , it usually occurs after meals , especially after heavier and fatty foods . in patients with problems , or symptoms due to gallstones ,
surgical treatment is necessary , because in 3% of these patients within a year occurs some form of complication .
the most common complications are : a ) acute inflammation of the gallbladder , when stone is stuck on the exit from the gall bladder and requires urgent surgery ; b ) choledocholithiasis ( stones from the gallbladder bile entering the conduits , which can be clogged ) ; c ) cholangitis ( purulent bile ducts ) ; d ) an acute inflammation of the pancreas ; e ) bowel obstruction by calculus ( if the stone passes into the duodenum or small intestine ) ; f ) carcinoma of the gallbladder .
the existence of the symptoms requiring diagnostic tests which prove the existence of stones or changes in the gall bladder .
routine diagnostics include : a ) clinical history ; b ) clinical examination ; c ) complete laboratory tests ; d ) x - ray of the lungs and heart ; and e ) echo examination .
additional diagnostic methods are ct and ercp . according to the report of the us national institute of health
, it is estimated that 6.3 million men and 14.2 million women , aged 20 - 74 years in the united states has calculosis of the gallbladder , due to which every year is performed about 700,000 cholecystectomy ( 1 ) . in patients with symptomatic gallstones treatment
surgical removal of the gallbladder is not performed because it  contains stones , but because it creates stones  . in today s world and in our county
the method of choice for removal of the gallbladder is considered laparoscopic cholecystectomy , which represents the  gold standard  .
male patient , aged about 40 years , admitted at the clinic and laparoscopic surgery was performed in our department for chronic , as multiple , symptomatic gallbladder calculi .
intraoperative findings showed chronically inflamed , curled gall bladder , and wall thickening . after the first postoperative day
there is no content in the drain bag and it is taken out , and the patient leaves the hospital without any problems .
the seventh post - operative day occurred abdominal pain , weakness and fatigue , with striking yellow skin and visible mucous membranes .
clinical , laboratory and echo determined abdomen full of fluids , so it was suspected lesion of the bile duct .
intraoperative was found a lesion of the common bile duct in the form of a complete interruption .
created is anastomosis through transhepatic drain according to pradera . early and late postoperative flow was entirely normal with normal laboratory and echofindings .
control , contrast imaging through a drain showed the orderly flow of extrahepatic bile ducts , with minimal extravasation of contrast .
figure 1 an 2 show operative reconstruction of iatrogenic lesions of the common bile duct .
as father of laparoscopic cholecystectomy is considered a french surgeon mouret , who in 1987 by laparoscopic method tourniquet artery and of the cystic duct , and removed gallbladder removed by mini laparatomy , but he did not publish his results ( 1 ) .
after him , this was performed by the french doctors dubois and perissat in 1988 .
mckennan and saye , the same year , performed the first laparoscopic cholecystectomy in the united states . in 2 - 4% of patients ,
this surgery can not be fully performed , so in that case it is performed a conversion ( traditional surgery ) .
national institutes of health of the united states passed in the 1992 conclusion that laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis .
the first country in south eastern europe which has accepted this conclusion was croatia ( 1997 ) .
after laparoscopic surgery , the patient leaves the hospital the same day , or the day after , and may begin with everyday activities after 6 - 7 days .
hypercoagulability of blood is lower due to less stress , which contributes to minimal danger of deep vein thrombosis and pulmonary embolism .
it was shown that laparoscopic cholecystectomy has significantly fewer complications than the open , but the iatrogenic lesions of the biliary tract occur twice or even three times more often .
already the first major multi - center study from europe and the united states has found such injuries in 0.5% of patients . the number of biliary tract injury during open cholecystectomy according to various authors
injury of luschkin duct is found in 33% of the patients and it is a frequent complication .
the biliary duct injury can be caused by lack of surgeon experience performing laparoscopy , but the cause may be difficult operating findings , such as gangrenous , acutely inflamed or atrophic gallbladder , which is a consequence of long - term chronic inflammation .
sometimes it is difficult to understand the anatomically changed relationships and erroneous surgical evaluation results in this complication .
a common injury of the anatomical relations is the connection of the cystic duct into the right hepatic duct .
mirizzi syndrome is a wide communication between infudibulum of the gallbladder and hepatic duct , so the surgeon can cut away part of hepatic duct thinking that it belongs to the gallbladder .
cala and colleagues describe two types for classification of biliary tract injuries during laparoscopy : a ) way classification and b ) bismuth classification . according to the type and severity of biliary tract injuries were divided into 5 groups ( way classification ) : 
 puncture or minor lateral cutting injuries to the duct;setting clips on the right or left hepatic duct , common hepatic duct or choledocus , but without cutting;full cut of the common hepatic duct or choledocus;completely cut of the right or left hepatic duct;strictures.with regard to the place of stricture bismuth and blumgart divided them into four groups : stricture affect more than 2 cm from the confluence;stricture affect less than 2 cm from the confluence;stricture at the confluence;strictures on the left or right gall duct . 
 
puncture or minor lateral cutting injuries to the duct ; setting clips on the right or left hepatic duct , common hepatic duct or choledocus , but without cutting ; full cut of the common hepatic duct or choledocus ; completely cut of the right or left hepatic duct ; with regard to the place of stricture bismuth and blumgart divided them into four groups : stricture affect more than 2 cm from the confluence ; stricture affect less than 2 cm from the confluence ; stricture at the confluence ; strictures on the left or right gall duct . in case of stab wounds or minor cuts symptoms occur after 2 to 4 postoperative days .
patients complain on pain under the right rib arc in the right shoulder , body temperature is elevated , expressed leukocytosis , hyperbilirubinemia , increased secretion of bile into the drain , 200 - 400 ml/24h .
that kind of injury can be solved by single resorbable sutures at the bile duct and/or by placing the t - drain .
early strictures and mistakenly placed clips on choledocus are reflected by strong biliary colic and progressive jaundice .
injuries caused by placing clips on choledocus will be resolved by repeated laparoscopy , with special emphasis on the vitality of the tissues to prevent stricture .
late strictures occur over weeks or months after surgery and cause a clinical picture of recurrent cholangitis and liver damage . to assess the injury of the bile ducts ,
can be used ct , mri , ercp , hida scintigraphy and percutaneous cholangiography . for sure completely cut choledocus
short choledocus defects can be reconstructed by direct suture only if they are less than 1 cm .
the problem of direct suture can be tensions in suture line or poor blood supply to the bile duct anastomosis line .
the tension can be reduced by mobilizing the duodenum . for defects larger than 1 cm required
the requirement for a good long - term outcome of biliodigestive anastomosis is good vitality of the bile duct tissues because if compromised , leading to biliary secretion , poor healing of the anastomosis and scarring .
it is important to prepare the bile duct as shorter as possible to preserve the nutritive vessels that run along it to the right and left sides .
anastomosis is performed with removed jejunal curve according to roux , termino - lateral , by resorbable suture 5/0 .
seams are single , and by making up nodes outside the lumen . as the choice of therapy should be considered also endoscopic choledocus drainage , setting prosthetics trough the papilla vateri and papillotomy .
prevention of biliary tract injuries , and thus the occurrence of enteric fistulas and recurrent cholangitis allow intraoperative cholangiography .
it is important to identify and classify injury to the biliary tract and make quality primary care for each following reconstruction attempt more difficult and demanding .
at the department of surgery of general hospital in konjic laparoscopic cholecystectomy is performed since 1999 . in the beginning
it was done by three trocars ( european style ) , and later , in order to prevent complications or injury of the bile duct is performed surgery with four trocars ( american style ) . the number of complicated procedures in our hospital does not differ from similar indicators in foreign surgical facilities .
 introduction : the formation of gallstones in the gall bladder is very common . it is now considered that approximately 10% to 15% of the adult population has gallstones . 
 it is more frequent in women than men.etiologies are various and include : age , sex , diet , sudden weight loss , etc . 
 according to the report of the us national institute of health , it is estimated that 6.3 million men and 14.2 million women , aged 20 - 74 years in the united states has calculosis of the gallbladder , due to which every year is performed about 700,000 cholecystectomy.case report : male patient , aged about 40 years , admitted at the clinic and laparoscopic surgery was performed in our department for chronic , as multiple , symptomatic gallbladder calculi . 
 intraoperative findings showed chronically inflamed , curled gall bladder , and wall thickening . after the first postoperative day 
 there is no content in the drain bag and it is taken out , and the patient leaves the hospital without any problems . 
 the seventh post - operative day occurred abdominal pain , weakness and fatigue , with striking yellow skin and visible mucous membranes . 
 clinical , laboratory and echo determined abdomen full of fluids , so it was suspected lesion of the bile duct . 
 urgent revision was performed . 
 intraoperative was found a lesion of the common bile duct in the form of a complete interruption 
 . created is anastomosis through transhepatic drain according to pradera . early and late postoperative flow was entirely normal with normal laboratory and echofindings . 
 control , contrast imaging through a drain showed the orderly flow of extrahepatic bile ducts , with minimal extravasation of contrast.conclusion:at the department of surgery of general hospital in konjic laparoscopic cholecystectomy is performed since 1999 . in the beginning 
 it was done by three trocars ( european style ) , and later , in order to prevent complications or injury of the bile duct is performed surgery with four trocars ( american style ) . the number of complicated procedures in our hospital does not differ from similar indicators in foreign surgical facilities . 