BILE-DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY - A COMMUNITY EXPERIENCE

Reports of bile duct injuries are from tertiary care institutions and, therefore, may not report the spectrum of management that these patie nts receive in the care of these injuries. From June 14, 1990 (the fir st operation) to June 30, 1995, 2654 laparoscopic cholecystectomies (L Cs) were reviewed at this community hospital medical center to determi ne risk factors contributing to the etiology of these injuries, time a nd symptoms at presentation, duration of illness, and management of th ese injuries. None of the 13 general surgeons practicing during this t ime period had laparoscopic training in a general surgical residency. There were six major bile duct injuries (0.25%), of which five were av ailable for further review. All occurred in women with cholelithiasis and chronic cholecystitis. Two operations were routine and two were as sociated with biliary tract anomalies. In two patients, the injuries w ere detected at LCs and definitive biliary-enteric anastomoses were pe rformed immediately. Three patients presented at 2, 15, and 42 days af ter LC. In two patients, one or more operative procedures were perform ed before definitive repair and these patients were referred to tertia ry care centers. One patient was managed with sequential CT-guided dra inage catheters after attempted closure of the defect. The length of i llness for these five patients was 8, 69, 348, 402, and 435 days with a follow-up of 245, 345, 531, 575, and 1088 days. Laparoscopic experie nce before injury by the operating surgeon was 3, 26, 35, 77, and 333 operations. Major biliary tract injuries occurred during routine chole cystectomy, length of illness was substantial for most patients, and b iliary-enteric anastomosis was definitive for four of the five patient s. The operating surgeons' ''learning curve'' did not seem as importan t as in other studies.