Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases

BACKGROUND/AIMS: Bile duct injuries during laparoscopic cholecystectomy are serious complications. The incidence of this complication increases compared with open cholecystectomy. The aim of this paper has been to audit the incidence and nature of bile duct injuries during laparoscopic cholecystectomy in a single center. METHODOLOGY: From January 1991 to September 2000, all laparoscopic cholecystectomy attempts performed in Rajavithi Hospital were analyzed. RESULTS: Of the 1522 procedures performed, there were 9 (0.59%) cases of bile duct injuries. These involved the common hepatic duct (n=3) and the common bile duct (n=6). The underlying gallbladder pathology included chronic cholecystitis (n=6), Mirizzi's syndrome (n=2), and acute cholecystitis (n=1). Transection of the duct accounted for the majority of the injuries. Six bile duct injuries were identified at the time of operation. These were primarily repaired by direct suture (n=1) or by a biliary-enteric anastomosis (n=5). In the remaining three patients, the diagnosis was delayed. Two patients presented with a large amount of bile from the drain after surgery and one patient presented with jaundice. These were repaired by direct suture over a T tube (n=1) or biliary-enteric anastomosis (n=2). One patient developed recurrent cholangitis following biliary-enteric anastomosis after delayed diagnosis. CONCLUSIONS: The experience of a 0.59% incidence of bile duct injury is comparable to the best results from most large series in the West. Inflammation/adhesion at Calot's triangle is an important associated factor for injury. Injuries identified and repaired at the time of the first operation afford good results.