Biliary complications associated with laparoscopic cholecystectomy - an analysis of common misconceptions

Background Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; compli cations occur in the presence of difficult anatomy/pathology; injuries occu r more proximally than at open cholecystectomy; most injuries are recognise d immediately and most can be managed non-operatively. The aim of our study was to determine if these views are substantiated in clinical practice. Methods The mode of presentation, management and outcome of thirty-two patients ref erred to a hepatobiliary unit over a seven year period were analysed. Results In 72% of cases the initial operator was a consultant. Five of the 32 compl ications (16%) occurred in the presence of difficult anatomy/pathology. Two patients had proximal biliary tree injuries, the only mortalities (two) oc curring in this group. Only 41% of injuries were detected immediately; 87% required surgical intervention, hepaticojejunostomy being the most common p rocedure performed (75%). Conclusion Our study shows that the majority of bile duct injuries are not caused by t rainees, do not occur because of unusual anatomy/pathology, do not occur in the proximal biliary tree and are not recognised at the time of operation. Most injuries ultimately require major reconstructive surgery for definiti ve management.