Bile Duct Injury During Laparoscopic Cholecystectomy

Abstract

Accepting that the survey bias underestimates the true frequency of bile duct injuries, residency training decreases the likelihood of injuring a bile duct, but only by decreasing the frequency of early "learning curve" injuries. If one accepts a liberal definition of the learning curve (200 cases), it appears that at least one third of injuries are not related to inexperience but may reflect fundamental errors in the technique of laparoscopic cholecystectomy as practiced by a broad population of surgeons in the United States. Intraoperative cholangiography is helpful for intraoperative discovery of injuries when they occur. Most injuries are repaired in the hospital where they occur and are not universally referred to tertiary care centers.

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

“…Archer et al [13] reported that routine use of IOC increased detection of BDI from 45 % to 85 %, which is similar to the increased detection described by Ludwig et al [9] from 45 % to 90 %. Intraoperative detection of a ductal injury should decrease the technical difficulty of a repair, because there is no infection, inflammation, or fibrosis in the operating field compared with a delayed repair.…”

“…Despite variation on opinions about the routine or selective use of IOC, it has demonstrated a reduction in the incidence of major BDI and expeditiously identifies insults at the time of surgery [2,13,52,59,[70][71][72][73]. Archer et al [13] reported that routine use of IOC increased detection of BDI from 45 % to 85 %, which is similar to the increased detection described by Ludwig et al [9] from 45 % to 90 %.…”

“…Traditionally, surgeons opt for operations with lower complication rates, and the ''learning curve'' was one of the arguments to account for the increased incidence of BDIs during LC [12]. However, further publications have reported that this incidence remains higher even when ''learning curve'' is accounted for [4,13,14], even in light of technological advances that have improved visualization and instrumentation [14][15][16][17][18]. Despite this evidence, LC remains the treatment of choice for symptomatic gallstones, a fact most likely attributable to the benefits of less postoperative pain, shorter hospital stay, better cosmetic result, and increased patient satisfaction [12,[19][20][21][22].…”

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…Most complications occurred during the first 50 procedures which, despite the limitations of the report, suggest that most lesions are associated with inadequate expertise. Nevertheless, at least a third of those lesions might be associated with other factors such as those derived from inappropriate surgical maneuvers (Archer, 2001). A similar study with a 58% response rate observed 75.7% of major lesions, with no differences between the type of technique used or the use of RIOC (Nuzzo, 2005), (Treatment studies 4).…”

Case series on endoscopic simultaneous multiple plastic stent dilatation of strictures following iatrogenic bile duct injury

“…Approximately 30% of bile duct injuries are identified during the primary surgery. Optimal management of an IBDI depends on several factors, including type of injury, associated vascular injuries, condition of the patient, timing of reconstruction and availability of expertise, and includes open surgical and endo-therapeutic options [2]. Reconstructive hepaticojejunostomy which is commonly performed, is associated with low mortality and low morbidity [3,4].…”