Complications of cholecystectomy: Risks of the laparoscopic approach and protective effects of operative cholangiography - A population-based study

Background Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystect omy (OC). Population-based studies are required to estimate the magnitude o f the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. Methods Suspected cases of intraoperative injury associated with cholecyste ctomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons under going postoperative endoscopic retrograde cholangiopancreatography. The cas e records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factor s. Results After the introduction of LC in 1991, the proportion of all cholecy stectomy cases with intraoperative injury increased from 0.67% in 1988-90 t o 1.33% in 1993-94. Similar relative increases were observed in bile duct i njuries, major bile leaks, and other injuries to bowel or vascular structur es. Increases in intraoperative injury were observed in both LC and OC. Aft er adjustment for age, gender, hospital type, severity of disease, intraope rative cholangiography, and calendar period, the odds ratio for intraoperat ive injury in LC compared with OC was 1.79. Operative cholangiography signi ficantly reduced the risk of injury. Conclusion Operative cholangiography has a protective effect for complicati ons of cholecystectomy. Compared with OC, LC carries a nearly twofold highe r risk of major bile, vascular, and bowel complications. Further study is r equired to determine the extent to which potentially preventable factors co ntribute to this risk.