Biliary complications during a decade of increased cholecystectomy rate

BACKGROUND: Bile duct injury is a rare complication of cholecystectomy. The aims of this study were to analyse the mechanism and outcome of biliary complications and determine the Northern Ireland incidence of bile duct injury over the last decade. METHODS: Annual numbers of cholecystectomies were obtained from the Northern Ireland Hospital Inpatient System database. Bile duct injury referrals to a hepatobililary unit over an 11-year period from 2000 were reviewed. Mechanism and recognition of injury, referral interval, management and outcome were analysed. RESULTS: The annual incidence of laparoscopic cholecystectomy in Northern Ireland increased from 0.038% in 1995 to 0.101% in 2009. Thirty-five patients with biliary complications from cholecystectomy were referred from 2000. The incidence of bile duct injury associated with laparoscopic cholecystectomy during this period was 0.2%. Only 26% of injuries were recognised intra-operatively, only 40% were referred immediately and 91% required operative intervention. CONCLUSION: The incidence of laparoscopic cholecystectomy has increased in Northern Ireland. The incidence of bile duct injuries over the last 11 years was 0.2%. Recognition and referral were delayed in most cases. The majority of injuries required operative management and long-term follow-up.