Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies.
OBJECTIVE
Bile duct injury (BDI) remains the most serious complication of cholecystectomy. With laparoscopic cholecystectomy (LC), the incidence has become more frequent. This study verifies the current incidence, mechanism, presentation, and treatment of BDI occurring during LC in general surgical practice.


METHODS
Anonymous retrospective multicenter survey.


METHODS
Department of surgery at a university referral center, collecting data from general surgical units.


METHODS
Data from 56 591 patients who underwent LC between January 1, 1998, and December 31, 2000, in 184 hospitals in Italy were analyzed.


METHODS
Current incidence, mechanism, presentation, and treatment of BDI occurring during LC in general surgical practice.


RESULTS
Two hundred thirty-five BDIs were reported, with an overall incidence of 0.42%. There were no risk factors in 80.0% of the patients. Poor identification of the anatomical features of the hepatic pedicle was the most frequently reported cause (36.8%), and technical problems accounted for 27.0% of causes. The incidence of BDI was higher during cholecystitis (P<.001) and decreased with increasing number of LCs performed by the surgical teams (P<.01). There was no difference in incidence according to technique (French or US) or to routine or selective intraoperative cholangiography. One hundred eight BDIs (46.0%) were recognized intraoperatively and immediately repaired in 89.8% of patients. One hundred twenty-seven BDIs (54.0%) were diagnosed postoperatively, the dominant manifestation being biliary fistula (44.1%).


CONCLUSIONS
This study confirms a higher incidence of BDI during LC. It highlights the relevance of the number of previously performed LCs and of the correct surgical technique to avoid BDI. The need for correct procedures, adequate expertise of the repairing surgeon in BDI repairs, and a multidisciplinary approach in the management of BDI is emphasized.
Nuzzo
Gennaro
G
Department of Surgical Sciences, Hepato-Biliary Surgery Unit, Catholic University, School of Medicine, Largo Agostino Gemelli 8, 00168 Rome, Italy. chirucsc@rm.unicatt.it
Giuliante
Felice
F
Giovannini
Ivo
I
Ardito
Francesco
F
D'Acapito
Fabrizio
F
Vellone
Maria
M
Murazio
Marino
M
Capelli
Giovanni
G
D000007:Abdominal Injuries / Q000453:epidemiology / Q000209:etiology*; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D012189:Retrospective Studies