LAPAROSCOPIC CHOLECYSTECTOMY, BILE-DUCT INJURY AND THE BRITISH AND IRISH SURGEON

Laparoscopic cholecystectomy continues to attract controversy with reg ard to a perceived higher incidence of bile duct injury than in the op en procedure. One possible cause for this is the trend away from intra operative cholangiography previously considered an essential part of t he open procedure. Under the auspices of The Association of Surgeons o f Great Britain and Ireland, a questionnaire was sent to all its consu ltant fellows asking for details about their individual experience of the most serious injury, bile duct resection. In all, 1100 questionnai res were sent; 362 (33%) replies were returned. Of those who replied, 300 performed laparoscopic cholecystectomy as part of their practice. The experience of the respondents was divided into three groups; 19 su rgeons had performed <50 laparoscopic cholecystectomies, 53 between 50 and 100 and 228 had performed over 100. Ninety-five (32%) never perfo rmed intraoperative cholangiography, 167 (56%) on a selective basis an d 38 (12%) routinely. In all, 58 bile duct resection injuries were rep orted by 48 surgeons. Of the bile duct resection injuries reported, 49 of 58 (85%) occurred when an intraoperative cholangiogram was not per formed. These figures suggest that if the incidence of bile duct resec tion injury is to be decreased in laparoscopic cholecystectomy, the us e of intraoperative cholangiography has an integral role to play.