BILE-DUCT INJURIES, 1989-1993 - A STATEWIDE EXPERIENCE

Objective: To review the incidence of major bile duct injuries (MBDI) during the shift from open (OC) to laparoscopic cholecystectomy (LC). Design: Cohort analysis; minimum 15-month patient follow-up Setting: A cute care Connecticut hospitals. Patients: Medical records of 30211 pa tients with cholecystectomy (OC or LC) reviewed; 47 cases of MBDI conf irmed. Main Outcome Measure: Rate of MBDI. Results: The incidence of M BDI in Connecticut hospitals rose from 0.04% in 1989 to 0.24% in 1991, then decreased to 0.11% in 1993. The increase was due to increased nu mbers of cholecystectomies and the initial increased risk of injury wi th IC. The 1990-through-1993 trend of decreasing incidence of LC MBDI was statistically significant (P=.02). By 1993, the difference between LC and OC was no longer significant (P=.81). Acute cholecystitis (odd s ratio, 3.3) and gallstone pancreatitis (odds ratio, 3.6) increased t he risk of MBDI during LC (P<.001). The LC MBDI more commonly were duc tal excision or transections and often were not diagnosed intraoperati vely. Intraoperative cholangiography facilitated intraoperative recogn ition and repair. Most patients (89%) underwent definitive management of the MBDI at the hospital of origin; of those, 5% required further i nterventions. Conclusions: Surgeries for acute cholecystitis and galls tone pancreatitis are associated with an increased risk for MBDI. Duct al anatomy, the timing of recognition of injury, and the method of rep air dictate patient outcomes. Most patients are successfully managed a t the hospital of origin, with good long-term results. Late bile duct strictures appear rare.