[A survey of bile duct injuries sustained during laparoscopic cholecystectomy].
OBJECTIVE
To summarize the reasons for bile duct injury (BDI) after laparoscopic cholecystectomy (LC), and to determine the effect of multiple treatment after BDI.


METHODS
A retrospective cohort study was performed. The medical records of 110 patients diagnosed with BDI after LC from October 1993 to November 2007, in ten large hospitals in Guangdong of China, were reviewed.


RESULTS
Among 110 patients with BDI, 58 cases (52.7%) were local patients, whereas 52 cases (47.3%) were transferred from outside hospitals. Reasons for BDI following LC were: (1) Lack of experience of the LC operator (48.2%); (2) LC performed during acute cholecystitis (20.0%); (3) The structure of Calot triangle was unclear (15.5%); (4) Variable anatomical position (11.8%); (5) Intra-operation bleeding (4.5%). The commonest sites of injury were the choledochus and common hepatic duct (76.4%). Following BDI, endoscopic stenting or operative repair was performed in 106 patients. The overall success rate was 95.3% (101/106), with a mortality rate was 0.9% (1/106). Cholangitis occurred in 3.8% (4/106) cases. Choledocho-enterostomy operation was performed in almost 60.0% (63/106) cases, and the success rate was 93.7% (59/63). Endoscopic stenting or operative repair was performed immediately following BDI in 23.6% (25/106) patients, the success rate was 100%; and within 30 days in 63.2% (67/106) patients. Eighty-eight out of 106 patients who underwent repair were successful following the first operative procedure.


CONCLUSIONS
Factors such as an un-experienced operator and unclear anatomical position were causes of BDI following LC. Early operative repair should be regarded as the treatment of choice, in patients diagnosed with BDI. Early refer to an experienced hepatobiliary operator ensures a high success rate.
Chen
Ya-jin
YJ
Department of Hepato-biliary Surgery, the Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Peng
Bao-gang
BG
Liang
Li-jian
LJ
Wang
Jie
J
Ou
Jin-rui
JR
Jian
Zhi-xiang
ZX
Huo
Feng
F
Zhou
Jie
J
Zhen
Zuo-jun
ZJ
Yu
Xiao-fang
XF
Deng
Mei-hai
MH
Tan
Zhi-jian
ZJ
Huang
Zong-hai
ZH
Zhang
Hong-wei
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies