Role of preoperative color doppler ultrasound scan in the evaluation of the risk of injury of major branches of the middle hepatic vein during laparoscopic cholecystectomy

During laparoscopic cholecystectomy, the separation of the gallbladder from the liver bed may sometimes cause severe hemorrhages. One reason for severe hemorrhages may be injury to the major branches of the middle hepatic vein (MHV), which may be too close or adherent to the gallbladder. In our institutional experience of 798 laparoscopic cholecystectomies, no major hemorrhage from the gallbladder bed has been encountered. The aim of this prospective study was to investigate the relationship between the major branches of the MHV and the gallbladder bed in our patients. We measured the distance of the closest branches of the MHV from the gallbladder bed by color Doppler ultrasound scan. The mean and the median distances of the closest branch of the MHV to the gallbladder was found to be 17.4 +/- 6.2 mm and 17.7 mm, respectively (range, 6-29.1 mm). In conclusion, the distance of the closest branch of the MHV to the gallbladder bed in our patient population seems to allow for a safe laparoscopic cholecystectomy.