The complicated cholecystectomy and management of perforation post-ERCP

Abstract

Over one million cholecystectomies are performed yearly in the USA. The incidence of bile duct injury as a result remains around 0.5 %. These injuries are generally avoidable. Bile duct injuries occur more commonly from misidentification of normal anatomy than from anatomic anomalies. In this chapter, we discuss preoperative factors that predict the difficult cholecystectomy, techniques to enable a safe cholecystectomy, and the pitfalls that lead to bile duct injury. Operative approaches to complete the difficult cholecystectomy in the setting of inflammation are also discussed. An injury classification system and management of post-ERCP perforation are reviewed.