Bile duct injuries associated with cholecystectomy

Guy Maddern, Government of South Australia, SA Health

Abstract

The era of laparoscopic cholecystectomy has been associated with a minor increase in the frequency of significant bile duct injuries. Contemporary studies indicate a frequency of approximately 0.5% for laparoscopic procedures when compared to a frequency of 0.1-0.3% for opening procedures. These complication rates decrease with increasing experience of the surgeon in some but not all studies. The mechanisms of biliary injury are varied but include unrecognised stones and strictures in the lower bile duct and mistakes in the identification of the cystic duct and common hepatic duct in the triangle of Calot. Other factors include the excessive use of cautery, excessive traction, inadvertent duct laceration and the inappropriate application of clips or sutures.