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Am J Surg. 2012 Apr;203(4):480-7. doi: 10.1016/j.amjsurg.2011.08.018. Epub 2012 Feb 9.

Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries?

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  • 1Department of Surgery, University of California, San Francisco, East Bay, Oakland, CA 94602, USA.

Abstract

BACKGROUND:

Two decades since the advent of laparoscopic cholecystectomy, the rate of bile duct injuries still remains higher than in the open cholecystectomy era.

METHODS:

The rate and complexity of bile duct injuries was evaluated in 83,449 patients who underwent laparoscopic cholecystectomy between 1995 and 2008 in the Kaiser Permanente Northern California system. Fifty-six surgeons who performed a laparoscopic cholecystectomy in the past were surveyed to determine factors that predispose to bile duct injuries.

RESULTS:

The overall incidence of bile duct injuries was .10%; 59.5% of the 84 injuries were cystic duct leaks. Incidence varied slightly from .10% (1995-1998) to .08% (1999-2003) and .12% (2004-2008). There was a trend toward more proximal injuries (injury <2 cm from the bifurcation: 14.3% to 44.4% to 50.0% of major injuries). The misinterpretation of anatomy was cited by 92.9% of surgeons as the primary cause of bile duct injuries; 70.9% cited a lack of experience as a contributing factor.

CONCLUSIONS:

Laparoscopic cholecystectomy has an overall low risk of bile duct injuries; the rate remains constant, but injury complexity may have increased over time.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22326050
[PubMed - indexed for MEDLINE]
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