The purpose of research. Searching for main features of iatrogenic injuries in laparoscopic operations and management for surgical correction.
Materials and methods: abdominal US, CT, punctual biopsy of the liver.
Results and discussion. Within the period from 2010 to 2014 there were performed 1,659 laparoscopic operations on abdomen in our hospital; in 7.1% of the cases there was a conversion. Injuries to extrahepatic bile ducts were observed in 14 patients, injures of arteries — in 4 patients, intestinal injures — in 4 patients and injuries of diaphragm — in 1 patient. The causes which influenced the appearance of the iatrogenic injures were divided into clinical-anatomical features, insufficiency of practical skills and experience of surgeon, technical condition of realization of operation (8 (34.7%) patients); expressed adhesive and inflammatory infiltrative changes in operations zone (7 (30.4%) patients); insufficiency of surgeon classification (5 (21.7%) patients). Relaparoscopy with sanitation and drain of abdomen was held during bile convolution more than 200 ml the drain on the first 2–3 days. Decompression of biliary tract was held by external nasobiliary drain. Endoscopic pappillosphincterotomy was held by the indication. During the injures of the main duct not more than half of the diameter the closure of the wound by putting internal drain was held. During the intersection of the main ducts excision its part hepaticojejunoanastomosis, biliobiliary anastomoses “end into the end” was executed. Traumas of surrounding organs caused conversion in 6 patients. Mortality among laparoscopic operating patients was 0.18%.