Biliary tract injury in laparoscopic cholecystectomy: results of a single unit.
BACKGROUND
Laparoscopic cholecystectomy was introduced into Australia in early 1990. Its rapid increase in acceptance was, however, tempered by reports of an increased incidence of bile duct injury. The aim of this study was to report on the incidence of biliary tract injuries in a single unit, comment on the way they were managed and look at strategies to prevent them.


METHODS
A retrospective audit was conducted on laparoscopic cholecystectomies performed between January 1992 and March 2001. The data was collated from patient medical record files and yielded a total of 1216 procedures.


RESULTS
There were 899 women (74%) and 317 men (26%), with an age range of 13-92 years. Most of the procedures were performed on an elective (94%) rather than emergent basis (6%). There was one bile duct injury (0.09%) and seven bile leaks (0.63%). The single injury involved common bile duct obstruction by a misplaced clip and was successfully managed by chol-angio-enteric bypass. Of the seven bile leaks, three were from the cystic duct stump, two from the gallbladder bed, and two were unidentified, settling conservatively. Of the five patients actively treated, two underwent therapeutic laparoscopy, two proceeded to laparotomy, and one was managed successfully by endoscopic stenting.


CONCLUSIONS
Single-centre studies such as this are important in ensuring that standards of surgery are maintained in a community setting.
Miroshnik
Michael
M
Sutherland Hospital, Sydney, New South Wales, Australia.
Saafan
Ahmed
A
Koh
Simon
S
Farlow
John
J
Neophyton
John
J
Lizzio
Joe
J
Yee
Frank
F
Ethell
Tony
T
Bean
Andrew
A
Fenton-Lee
Douglas
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies