Bile duct imaging and injury: a regional audit of laparoscopic cholecystectomy.
BACKGROUND
The aim of the present study was to report details of practice with respect to bile duct imaging and bile duct injury.


METHODS
A prospective audit of laparoscopic cholecystectomy (LC) was undertaken in the Otago region from the introduction of LC in 1991 through to December 1995. The audit includes all procedures done by all surgeons in public and private hospitals over the period without exclusion.


RESULTS
Laparoscopic cholecystectomy was attempted in 929 patients and completed laparoscopically in 832 (89.6%). Intraoperative cholangiography (IOC) was undertaken with increasing frequency over the study period, from 5.9% in 1991 to 32.2% in 1995. The overall IOC rate for individual surgeons varied from 4.5 to 47.6%. The use of peri-operative endoscopic retrograde cholangiopancreatography (ERCP) increased with the introduction of LC but has plateaued at approximately 6%. A total of 15.4% of patients with one or more clinical indicators of choledocholithiasis underwent LC without any form of bile duct imaging. Eight main bile duct injuries (0.86%) and a further 18 bile leaks occurred (total bile duct injury rate 2.8%). Intra-operative cholangiography was attempted (unsuccessfully) in only one patient with main duct injury, although five of the eight injuries were recognized intra-operatively.


CONCLUSIONS
This prospective regional audit demonstrates a gradual return to the use of IOC, a modest but stable reliance on peri-operative ERCP, and a higher than expected rate of bile-duct injury.
Merrie
A E
AE
Department of Surgery, University of Otago Medical School, Dunedin, New Zealand.
Booth
M W
MW
Shah
A
A
Pettigrew
R A
RA
McCall
J L
JL
D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000592:standards; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007432:Intraoperative Period; D008485:Medical Audit; D009520:New Zealand; D011446:Prospective Studies