Bile duct injury and bile leakage in laparoscopic cholecystectomy

Abstract

The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.

Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury

“…Limited postoperative discomfort, shorter hospitalization, and rapid postoperative recovery have been proven to be advantageous of the procedure. Concomitantly, it became obvious that the incidence of bile duct injury rose from 0.06% to 0.3%, as known for open cholecystectomy, to 0.5% to 1.4% when performed laparoscopically [2][3][4][5][6] . Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity and mortality [7,8] , reduced long-term survival and quality of life [9,10] , and high rates of subsequent litigation.…”

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

“…Bismuth's classification (Type I-V) of BDI/stricture precluded the advent of LC but helped surgeons to choose the type of repair and correlated well with outcome [24,25]. McMahon et al [26] then further subdivided the type of BDI into laceration, transection, or excision, while retaining Bismuths classification to grade the level of the stricture. Minor and major injuries also were distinguished for the purposes of management; minor required a simple suture repair and/or insertion of a T-tube, whereas a hepaticojejunostomy was recommended to treat a major injury [26].…”

“…McMahon et al [26] then further subdivided the type of BDI into laceration, transection, or excision, while retaining Bismuths classification to grade the level of the stricture. Minor and major injuries also were distinguished for the purposes of management; minor required a simple suture repair and/or insertion of a T-tube, whereas a hepaticojejunostomy was recommended to treat a major injury [26]. Strasberg's classification (Type A-E) is a comprehensive modification of Bismuth's classification that includes various other types of laparoscopic extrahepatic BDIs [11].…”

Laparoscopic Cholecystectomy for Gallstones: A Comparison of Outcome between Acute and Chronic Cholecystitis

“…42 In a review article, the incidence of BDI in OC ranged from 0.0%-0.5%, while in LC a range of 0.0%-18%, with a mean of 0.3%, was reported in studies involving over 300 cases in a multicenter series. 43 Some authors consider AC a risk factor, 25 and an incidence of 0.4% has been reported, 24 but others have reported no such incidence. 23,28,44 We had no clinically detected cases of BDI in the patients with AC, but there were three female cases (3/785, 0.38%) in the patients with CC.…”