Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center.
BACKGROUND
Laparoscopic cholecystectomy has a higher incidence of bile-duct injuries than open cholecystectomy. Although a learning curve phenomenon was attributed to biliary injuries early after its introduction, we were interested in trends in biliary injury rates over time as laparoscopic cholecystectomy has become a mature technology.


OBJECTIVE
To analyze the frequency and anatomic distribution of bile-duct injuries referred after laparoscopic cholecystectomy over a 10-year period.


METHODS
Retrospective, case-series.


METHODS
Tertiary, referral hepatobiliary unit.


METHODS
Referrals to ERCP unit for diagnosis and treatment of biliary injuries after laparoscopic cholecystectomy.


METHODS
ERCP to diagnose level and severity of bile duct injury.


METHODS
Type and anatomy of bile-duct injury, reason for cholecystectomy, mean time between injury and diagnosis, presenting symptoms, ratio of bile-duct injuries diagnosed over total ERCPs done per year.


RESULTS
There were 87 bile-duct leaks, 28 leaks with stones, 51 strictures, and 17 complete duct transactions. The bile-duct injury rate calculated per 100 ERCPs per year was 0.84 (1994), 0.99 (1995), 1.36 (1996), 1.41 (1997), 1.03 (1998), 1.31 (1999), 0.84 (2000), 0.75 (2001), 1.15 (2002), and 0.94 (2003).


CONCLUSIONS
Single institution, retrospective analysis, unknown denominator of cholecystectomies done in referral area per year to calculate true bile-duct injury rate.


CONCLUSIONS
Static incidence in frequency, anatomic distribution, and rate per 100 ERCPs per year of postcholecystectomy bile-duct injuries at a tertiary referral hepatobiliary unit over a 10-year period of observation.
Khan
Mubashir H
MH
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Howard
Thomas J
TJ
Fogel
Evan L
EL
Sherman
Stuart
S
McHenry
Lee
L
Watkins
James L
JL
Canal
David F
DF
Lehman
Glen A
GA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies