Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years

Abstract

Background: Biliary injuries during laparoscopic cholecystectomy (LC) are complications better avoided than treated. These injuries cause long-lasting morbidity and can be fatal. The authors present their experience with biliary injury in LC during a period exceeding 13 years.

Methods: Between January 1992 and December 2005, 13,305 LCs were performed at the authors' institution. The biliary injuries in these cases were recorded and analyzed retrospectively.

Results: A total of 52 biliary injuries were identified in 13,305 LCs, for an overall incidence of 0.39%. Of these, 32 (0.24%) were diagnosed intraoperatively and 20 (0.15%) were diagnosed postoperatively. The perioperative bile duct injuries (BDIs) included 6 complete transections (5 treated by hepaticojejunostomy and 1 by primary T-tube repair (TTR), all performed by conversion to open procedure), 11 lateral BDIs (2 treated by laparoscopic choledochojejunostomy [CJ], 1 by open CJ, 5 by laparoscopic TTR, 1 by open TTR, and 2 by primary suture repair, both performed laparoscopically), 11 duct of Luschka injuries, and 4 sectoral duct injuries. The BDIs detected postoperatively included 6 patients with bilioma (treated with ultrasonography-guided aspiration), 4 patients with biliary peritonitis (requiring relaparoscopy and peritoneal lavage and drainage followed by endoscopic retrograde cholangiography [ERC] and biliary stenting), and 10 patients with persistent biliary leak-controlled biliary fistula (requiring ERC and stenting). There was no mortality related to BDI in the series. Patients with Strasberg type A/C/D injuries (46 cases) were followed 3 months to 3 years with no major complaints. Two patients with complete transection were lost to follow-up evaluation, whereas the other four patients, followed 18 months to 3 years, were asymptomatic.

Conclusions: According to the findings, LC is a safe procedure with an incidence of biliary injury comparable with that for open cholecystectomy. Single-center studies such as this are important to ensure that standards of surgery are maintained in the community.