BILE-DUCT INJURY AFTER LAPAROSCOPIC CHOLECYSTECTOMY - THE UNITED-STATES EXPERIENCE

Background: Forty series reporting experience with laparoscopic cholec ystectomy in the United States from 1989 to 1995 were reviewed. A tota l of 114,005 cases were analyzed and 561 major bile duct injuries (0.5 0%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Intraoperative cholangiography (IOC) was attempted in 41.5% of the laparoscopic cholecystectomies and was successful in 82.7%. In major bile duct injuries, the common bile duct/common hepatic duct wer e the most frequently injured (61.1%) and only 1.4% of the patients ha d complete transection. Methods: When reported, most of the bile duct injuries were managed surgically with a biliary-enteric anastomosis (4 1.8%) or via laparotomy and t-tube or stent placement (27.5%). The lon g-term success rate could not be determined because of the small numbe r of series reporting this information. The management for bile leaks usually consisted of a drainage procedure (55.3%) performed endoscopic ally, percutaneously, or operatively. Results: The morbidity for lapar oscopic cholecystectomy, excluding bile duct injuries or leaks, was 5. 4% and the overall mortality was 0.06%. It was also noted that the con version rate to an open procedure was 2.16%. Conclusions: It is conclu ded based on this review of laparoscopic cholecystectomies that the mo rbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholec ystectomy. Furthermore, bile duct injuries can be minimized by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-co mmon bile duct junction.