title: Comparison of major bile duct injuries following laparoscopic cholecystectomy and open cholecystectomy.
abstract: BACKGROUND
  The mechanism and extent of major bile duct injuries following laparoscopic cholecystectomy differ from those of open cholecystectomy.
  
  
  METHODS
  To identify differences in the demographic profile, timing of injury detection, management strategies and outcome, we undertook a retrospective review and analysis of our experience with 55 major bile duct injuries following both laparoscopic and open cholecystectomies over a period of 9 years.
  
  
  RESULTS
  Thirty-one major bile duct injuries resulted from laparoscopic cholecystectomy (56%) and 24 of them were sustained after open cholecystectomy (44%). The median time of presentation was 7 days after laparoscopic cholecystectomy and 14 days following open cholecystectomy (P < 0.001). Twenty-eight (51%) patients had injuries recognized intraoperatively in both groups, of whom 18 patients underwent an attempt at primary repair before referral. All patients required subsequent surgical intervention. There were no differences in the clinical presentations between the two groups. However, serum alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase levels were significantly higher following open cholecystectomy (P < 0.05). There was no significant difference in the level of injury between the two groups. All patients underwent surgical repair in the form of a Roux-en-Y hepaticojejunostomy (including two revision hepaticojejunostomies in each group). Surgical outcome did not differ between the groups; however, better results were seen with Bismuth grades 1 and 2 strictures compared with Bismuth grades 3 and 4 strictures for both groups (P < 0.002).
  
  
  CONCLUSIONS
  Major bile duct injuries following laparoscopic cholecystectomy present earlier and with lower levels of serum alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase. There does not appear to be a significant difference between the Bismuth-Strasberg grading of the strictures and the type of surgery carried out.
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. kamanlil@yahoo.com
authors.forename: Lileswar
authors.initials: L
authors.lastname: Kaman
authors.forename: Sudip
authors.initials: S
authors.lastname: Sanyal
authors.forename: Arunanshu
authors.initials: A
authors.lastname: Behera
authors.forename: Rajinder
authors.initials: R
authors.lastname: Singh
authors.forename: Rabindra N
authors.initials: RN
authors.lastname: Katariya
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D002763:Cholecystectomy / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies