CONTINUING HAZARDS OF THE LEARNING-CURVE IN LAPAROSCOPIC CHOLECYSTECTOMY

Bile duct injury is one of the most serious complications of laparosco pic cholecystectomy (LC). In open cholecystectomy (OC) the reported in cidence of injury is less than 0.2 per cent. In LC, the aggregate repo rted experience, in many thousands of cases, is three or four times th is number. Although ''the learning curve'' has been considered the pri ncipal factor in the heightened incidence of this complication with LC , there are hazards inherent in this new surgical modality that may ne ver allow elimination of the increased risk of bile duct injury. As a sequel to an earlier report of 1200 cases of OC before the laparoscopi c era from a single institution, this report deals with the next 2427 consecutive cases of LC from the same institution. In the first 1284 c ases of LC, there were seven bile duct injuries (0.58%); in the ensuin g 1143 cases there were six bile duct injuries (0.50%). The overall in cidence nationwide is even higher, as evidenced by widespread reports of repair of bile duct injuries referred to major tertiary care center s. Routine operative cholangiography is of the utmost importance in th e early recognition and immediate repair of ductal injuries. In 12 of the 13 cases reported here, early recognition and repair during the pr imary surgery resulted in a successful outcome.