Bile Duct Injuries in Connection With 2500 Laparoscopic Cholecystectomies

Background: Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and complication rate seem to be higher than in standard open surgery. Methods: In this paper the authors report their guiding principles in applying LC and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished during the past 4.5 years. Results: Seventeen ductal injuries occurred in the whole series, which means an overall incidence rate of 0.68%. Data obtained in the last period, however, show a decrease down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent. The various complications of these injuries caused the death of two patients. Conclusions: The great number of intraoperatively undetected injuries, many of them arising not due to technical difficulties, suggest the possibility of an injury caused by electric current. Depending on the type of injury direct suture, T-tube drainage or biliodigestive anastomosis can equally be effective. Long established practice and experience can help reduce the occurrence of complications to the level in standard open surgery.