title: Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy?
abstract: BACKGROUND
  Bile duct injuries (BDI) have been reported to occur more frequently during laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Several studies have demonstrated various potential predisposing factors for BDI. However, there is a controversy as to whether gallbladder inflammation is a significant predictor for BDI. Therefore, out primary aim was to investigate the relationship between inflammation and BDI at LC, and secondarily to present the management and clinical outcome of BDI.
  
  
  METHODS
  We recorded all consecutive LC performed between 1993 and 2005 in our institution by nine staff surgeons. BDI were classified according to Strasberg's classification. Simple and multivariate logistic regression analysis was performed to evaluate the association between inflammation and BDI occurrence during LC.
  
  
  RESULTS
  There were 2,184 patients. Among those, 344 had inflammation (16%). The conversion rate was 5% and was higher among male, elder patients, and those with inflammation. The BDI incidence was 0.69% (0.14% for major and 0.55% for minor injuries) and it was significantly higher in those with inflammation compared to those without inflammation (p = 0.01). In particular, the risk for BDI was almost 3.5 times higher in those with inflammation (OR = 3.61, 95% CI 1.27-10.21). Inflammation remained an independent risk factor for BDI even after adjustment for potential confounders. Among patients sustaining injury, one died and two have recurrent cholangitis. No association was observed between clinical outcome and management of BDI, time of diagnosis, sex, and inflammation.
  
  
  CONCLUSIONS
  We revealed that inflammation is an independent predictor of BDI occurrence during LC. Therefore, it would be advisable for surgeons to not hesitate to convert a LC to an OC in the presence of inflammation.
authors.affiliation: 3rd Surgical Department and Laparoscopic Unit, Evangelismos General Hospital, Athens, Greece. geophchris@yahoo.gr
authors.forename: Christos P
authors.initials: CP
authors.lastname: Georgiades
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Mavromatis
authors.forename: Georgia C
authors.initials: GC
authors.lastname: Kourlaba
authors.forename: Stylianos A
authors.initials: SA
authors.lastname: Kapiris
authors.forename: Eugenios G
authors.initials: EG
authors.lastname: Bairamides
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Spyrou
authors.forename: Charalambos N
authors.initials: CN
authors.lastname: Kokkinos
authors.forename: Christina S
authors.initials: CS
authors.lastname: Spyratou
authors.forename: Marios I
authors.initials: MI
authors.lastname: Ieronymou
authors.forename: Georgios I
authors.initials: GI
authors.lastname: Diamantopoulos
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D002761:Cholangitis / Q000150:complications; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000150:complications*; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D004487:Edema; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D005704:Gallbladder / Q000473:pathology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000150:complications; D016896:Treatment Outcome