RISK-FACTORS FOR BILE-DUCT INJURY IN LAPAROSCOPIC CHOLECYSTECTOMY - ANALYSIS OF 49 CASES

Forty-nine bile duct injuries, representing 0.8 per cent of 6076 lapar oscopic cholecystectomies performed in the Netherlands in 1990-1992, w ere reviewed. The aim of the study was to classify the injuries accord ing to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity o f the injury. On the basis of operative findings, bile duct injuries w ere classified from minor (classes I-IIIa) to extensive with loss of b ile duct tissue (lIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa , 18 in class IIIb and four in class IV. in 16 patients the injury was detected during laparoscopic cholecystectomy and the procedure conver ted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of t hese 16 patients. In 20 of the 33 patients in whom identification of t he injury was delayed to a second or third operation, more severe type s of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P=0.002). Of eight patients with hi stologically proven acute cholecystitis at cholecystectomy, seven suff ered severe injury (class IIIb or IV). Surgical experience with laparo scopic cholecystectomy was an important factor in the incidence of bil e duct injury.