Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries?

Am J Surg. 2012 Apr;203(4):480-7. doi: 10.1016/j.amjsurg.2011.08.018. Epub 2012 Feb 9.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bile Ducts / injuries*
  • California
  • Cholecystectomy, Laparoscopic / adverse effects*
  • Cholecystectomy, Laparoscopic / methods
  • Clinical Competence*
  • Databases, Factual
  • Female
  • Health Care Surveys
  • Humans
  • Incidence
  • Injury Severity Score
  • Intraoperative Complications / diagnosis*
  • Intraoperative Complications / epidemiology*
  • Male
  • Practice Patterns, Physicians' / trends
  • Risk Assessment
  • Surveys and Questionnaires
  • Time Factors