Bile duct injury during laparoscopic cholecystectomy - Myth or reality of the learning curve?

Background: Bile duct injury (BDI) is a severe complication of laparoscopic cholecystectomy (LC) that is probably related to the effects of the learni ng curve. The aim of this prospective, institutional, and longitudinal stud y is to compare the incidence of BDI during LC in relation to the progressi ve experience of surgeons. Methods: A total of 784 LC were examined during a 6-year period. They were divided into the following three consecutive groups: group A (1993-94), gro up B (1995-96), and group C (1997-98). Incidence and type of BDI, experienc e of the surgeon, intra- or postoperative diagnosis, treatment performed to repair the injury, and early and late morbidity and mortality were evaluat ed. Results: The overall incidence of BDI was 1.4%. There were three cases of t ransection of the common bile duct, four partial lesions of the bile duct, and four cystic leakages. The number of BDI was maintained over the three d ifferent time periods; there were no statistical differences in the proport ion of injuries among groups. Most BDI were incurred by experienced surgeon s. In all, 36% of BDI were recognized intraoperatively. Hepaticojejunostomy , direct suture over a T-tube, and closure of the cystic stump were done to repair BDI. There was no additional morbidity or mortality in the patients with BDI, Conclusions: No relation was found between the experience of the surgeon an d the number of BDI over the different periods of time. Therefore, BDI duri ng LC cannot be attributed solely to the learning curve.