Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries?
BACKGROUND
Two decades since the advent of laparoscopic cholecystectomy, the rate of bile duct injuries still remains higher than in the open cholecystectomy era.


METHODS
The rate and complexity of bile duct injuries was evaluated in 83,449 patients who underwent laparoscopic cholecystectomy between 1995 and 2008 in the Kaiser Permanente Northern California system. Fifty-six surgeons who performed a laparoscopic cholecystectomy in the past were surveyed to determine factors that predispose to bile duct injuries.


RESULTS
The overall incidence of bile duct injuries was .10%; 59.5% of the 84 injuries were cystic duct leaks. Incidence varied slightly from .10% (1995-1998) to .08% (1999-2003) and .12% (2004-2008). There was a trend toward more proximal injuries (injury <2 cm from the bifurcation: 14.3% to 44.4% to 50.0% of major injuries). The misinterpretation of anatomy was cited by 92.9% of surgeons as the primary cause of bile duct injuries; 70.9% cited a lack of experience as a contributing factor.


CONCLUSIONS
Laparoscopic cholecystectomy has an overall low risk of bile duct injuries; the rate remains constant, but injury complexity may have increased over time.
Department of Surgery, University of California, San Francisco, East Bay, Oakland, CA 94602, USA.
Kelley I
KI
Chuang
Douglas
D
Corley
Debbie A
DA
Postlethwaite
Maqdooda
M
Merchant
Hobart W
HW
Harris
D001652:Bile Ducts / Q000293:injuries*; D002140:California; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D002983:Clinical Competence; D016208:Databases, Factual; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000639:trends; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013997:Time Factors