Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat.
BACKGROUND
Despite improvement in the technique and increasing experience, complications of different nature and severity continue to occur during laparoscopic cholecystectomy all around the world. We present bile duct injuries in this series with regards to the incidence, severity and management of this problem.


METHODS
Descriptive.


METHODS
Department of surgery, Liaquat University of medical and Health Sciences, Jamshoro and other private hospitals at Hyderabad city during April 2003 to December 2007.


METHODS
A total of 1132 patients with symptomatic gallstone disease were included in the study regardless of their age and gender. Laparoscopic cholecystectomy by classical four-port technique performed in all cases with few amendments as per situation. Patients with growth in gallbladder and with severe associated medical or cardiac problems were excluded from the study. Details of every patient collected on a proforma and data finally analyzed on SPSS version 10.


RESULTS
Of total 1132 patients, 1088 (96%) were females and 44 (4%) were males with a mean age of 47.64 years. Elective laparoscopic cholecystectomy was performed in 1118 (98.7%) patients whereas emergency laparoscopic cholecystectomy was done in 14 (1.23%) patients. Various types of common bile duct injuries as well as post -operative bile leaks and their management is discussed with a view to improve upon the technique and out come.


CONCLUSIONS
Iatrogenic biliary injuries continue to occur despite tremendous overall improvement in technique and expertise.
Malik
Arshad M
AM
Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro 7800, Pakistan. arshadhamzapk@yahoo.com
Laghari
Abdul Aziz
AA
Talpur
Altaf Hussain
AH
Khan
Asad
A
D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003135:Common Bile Duct / Q000293:injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index