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. 2024 Dec 22;16(12):e76216.
doi: 10.7759/cureus.76216. eCollection 2024 Dec.

Bile Duct Injury During Laparoscopic Cholecystectomy: Has Anything Changed in 32 Years of Queensland Experience?

Bardia Bidarmaghz  1 , Nestor Sabat  2 , Peter Hodgkinson  1 , Thomas O'Rourke  1 , Nick Butler  1 , Shinn Yeung  1 , Kellee Slater  1
Affiliations

Bile Duct Injury During Laparoscopic Cholecystectomy: Has Anything Changed in 32 Years of Queensland Experience?

Bardia Bidarmaghz et al. Cureus. .

Abstract

Background Bile duct injury (BDI) is a serious complication of laparoscopic cholecystectomy (LC). Large studies report an incidence of 0.08%-0.3%, but they also suggest that BDI in the LC era is more severe than in the era of open cholecystectomy. In light of our reported experience of managing BDI in 2002, this study aims to evaluate changes over the past two decades. Methods A single-center retrospective review for all patients referred to the hepatobiliary surgeons at the Princess Alexandra Hospital in Queensland, Australia for the management of BDI that occurred during LC from January 2001 to May 2022. This was compared to our historical data from 1990 to 2000 and statistically analyzed. Demographic characteristics, type of injury, intra-operative cholangiogram completion, attempted repair, the timing of referral to the tertiary center, and definite repair of BDI were analyzed. Results Sixty-five patients were referred to us with a similar severity of BDI to our previous study, but analysis showed an increase in intraoperative recognition of the injury to 74.4% (32 out of 43 patients). Additionally, the number of intra-operative cholangiograms performed increased dramatically to 66.2% (43 patients) which resulted in an increase in recognition of BDI. Conversion rate to open technique and attempted primary repair by operating surgeon decreased to 63% (27 patients) and 16% (11 patients), respectively, with referral time significantly shortened (P-value < 0.001). Conclusion The past two decades show an increased recognition of BDI, use of intra-operative cholangiogram, and decreased attempts to repair by the operating surgeon which can result in significant long-term complications. Instead, early recognition of BDI is critical for improved patient outcomes alongside expedited referral and appropriate surgical management by a hepatobiliary surgeon at a tertiary center.

Keywords: bile duct injury; endoscopic retrograde cholangiopancreatography (ercp); intraoperative cholangiogram; laporoscopic cholecystectomy; roux-en-y hepaticojejunostomy; strasberg classification.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of Metro South Research Governance issued approval HREC/2022/QMS/88451. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Number of BDI repaired per year 2001–2022.
There was zero referral to our center in 2021 due to decreased number of elective laparoscopic cholecystectomy during the COVID-19 pandemic.
See this image and copyright information in PMC

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