Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Abstract

Background: Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. Methods: Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. Results: Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality. Conclusion: LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.

Robotic cholecystectomy: training of residents in use of the robotic platform

“…When analyzing previously published complication rates of laparoscopic cholecystectomy with those in our study (Table 1), the rates are comparable with other series (23)(24)(25). We still believe, however, that larger cohort sizes are needed in order to validate our findings that robotic cholecystectomy is a safe and feasible procedure to introduce residents to the field of robotic surgery without experiencing increased complications, as was seen with the introduction of the laparoscopic approach.…”

Elective laparoscopic cholecystectomy without intraoperative cholangiography: role of preoperative magnetic resonance cholangiopancreatography - a retrospective cohort study

“…Most surgeons argue that it should be reserved only for patients with strong signs of suspected CBD stones, or in the case of uncertain anatomy. There is also an increasing trend to perform LC without IOC, relying on perioperative screening [ 8 – 11 ].…”

Recommendation for cholecystectomy protocol based on intraoperative ultrasound – a single-centre retrospective case-control study

“…In the case of inflammation relying solely on this method may lead to BDI and it should be abandoned as the only method of visualization [9]. to an open approach in doubtful cases [10]. Another problem with IOC may be the misinterpretation of the view, resulting in CBD cannulation and injury requiring conversion, repair over T-tube or reconstruction [9].…”