الفهرس 
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Abstract
Laparoscopic cholecystectomy has become the first choice of management for symptomatic cholecystolithiasis. Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity and mortality, reduced long-term,
suryiva13 and quality of life, and high rates of subsequent litigation6. It
should be regarded as preventable. The advent of laparoscopic ch~lecystectomy has resulted in a resurgence of interest in bile duct injury and its subsequent management. Population-based studies suggest a significant increase in the incidence of injury (0.1 to 0.5 per cent) followIng the implementation of the laparoscopic approach.
Common anomalies responsible for bile duct injuries include those of the cystic duct (CD) and its insertion into the common hepatic duct (CHD) e.g. long parallel course with the CHD or a spiralling CD opening on il\e medial aspect of the CHD. Anomalies of the right hepatic duct (RHD) e.g. low insertion on to the CHD, right anterior and posterior sectoral hepatic ducts, anomalies of the right hepatic artery and aberrant ves~els coursing along the common bile duct (CBD) are other important examples. Acute inflammation around the Calot’s triangle makes the tissue friable and difficult to grasp. Dissection in such conditions leads to exc;essive oozing of blood. These along with the distorted anatomy
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increase the risk of bile duct injuries during LC. Extensive fibrosis around
the Calot’s triangle in cases with chronically inflamed and fibrosed gall
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bladder may similarly preclude safe dissection. In such cases partial
cholecystectomy is justified as otherwise there remains a high risk of bile duct injuries.