title: Iatrogenic common bile duct injuries: Increasing complexity in the laparoscopic era: A prospective cohort study.
abstract: OBJECTIVE
  Iatrogenic bile duct injury (BDI) is the most significant associated complication to laparoscopic cholecystectomy (LC). Little is known about the evolution of the pattern of BDI in the era of laparoscopy. The aim of the study is to assess the pattern of post-LC BDIs managed in a tertiary referral centre.
  
  
  METHODS
  Post-LC BDI referred over two decades were studied. Demographic data, type of BDI (classified using the Strasberg System), clinical symptoms, diagnostic investigations, timing of referral, post-referral management and morbidity were analysed. The pattern of injury, associated vascular injuries rate and their management were compared over two time periods (1992-2004,2005-2014).
  
  
  RESULTS
  78 BDIs were referred. During the second time period Strasberg A injuries decreased from 14% to 0 and Strasberg E1increased from 4% to 23%, the rate of associated vascular injury was six time higher (3.6% versus 22.7%), more patients had an attempted repair at the index hospital (16% versus 35%) sand fewer patients could be managed without surgical intervention at the referral hospital (28% versus 4%).
  
  
  CONCLUSIONS
  Complexity of referred BDIs and rate of associated vascular injuries have increased over time. These findings led to more patients managed requiring surgical intervention at the referral hospital.
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: N M
authors: NM
authors: Hogan
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: dorcaratto.dimitri@gmail.com.
authors: D
authors: D
authors: Dorcaratto
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: A M
authors: AM
authors: Hogan
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: F
authors: F
authors: Nasirawan
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: P
authors: P
authors: McEntee
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: D
authors: D
authors: Maguire
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: J
authors: J
authors: Geoghegan
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: O
authors: O
authors: Traynor
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: D C
authors: DC
authors: Winter
authors: St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors: E
authors: E
authors: Hoti
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D015331:Cohort Studies; D003135:Common Bile Duct / Q000293:injuries*; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D016896:Treatment Outcome
keywords: Bile duct injury; Bile duct repair; Cholecystectomy; Laparoscopy