HOW, WHEN, AND WHY BILE-DUCT INJURY OCCURS - A COMPARISON BETWEEN OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

Background: Bile duct injury (BDI) is a severe complication of laparos copic cholecystectomy (LC). There is general agreement about the incre ase of this complication after LC vs open cholecystectomy (OC), but co mparative studies are scarce. The aim of this paper has been to compar e the incidence and clinical features of BDI after LC vs open procedur es. Materials and methods: 3,051 OC, performed from June 1977 to Decem ber 1988 were retrospectively analyzed and compared with 1,630 LCs per formed from June 91 to August 96, for which data were prospectively re corded. Age, sex, type of BDI, performance of intraoperative cholangio graphy (IOC), underlying biliary pathology, morbidity, mortality, and late morbidity were all analyzed. Results: BDI incidence was higher in group II (LC) (N: 16, 0.95%) than in group I, (OC, N: 19, 0.6%). BDI incidence was also higher in the group of patients in which it was nec essary to convert to an open procedure (3/109, 2.7%, p < 0.05). BDIs w ere more frequently diagnosed intraoperatively in group I (OC, 18/19) than in group II (LC, 12/16). In both groups, BDI was more prevalent i n cases operated by staff surgeons than residents, mainly in complicat ed gallbladder patients, with a bile duct of less than 7-mm diameter. Morbidity, postoperative stay, mortality, and late morbidity were simi lar after a BDI in both types of approach. Conclusion: (1) BDI increas es with LC. (2) BDI after LC carries a similar postoperative morbidity and mortality to those after OC. (3) Incidence of BDI in converted ca ses increases significantly and this constitutes a high-risk group.