How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy?

Background and Purpose: Bile duct injuries sustained during laparoscopic ch olecystectomy differ from those of open cholecystectomy. The authors conduc ted a retrospective analysis of their experience with 124 major bile duct i njuries to identify these differences. Patients and Methods: Biliary injury in 83 patients (67%) was sustained dur ing open cholecystectomy, while in 41 patients (33%), it occurred during la paroscopic cholecystectomy. Intraoperative recognition was possible in 21 p atients (25%) in the former group and in 14 patients (34%) in the latter (P < 0.05). Results: The median time of presentation after laparoscopic cholecystectomy was 37 days v 240 days after open cholecystectomy (P < 0.001). Twenty-eigh t patients presented with external biliary fistulae in both groups. Spontan eous closure of these fistulae occurred in 21 patients (75%) in the open ch olecystectomy group and in only 10 patients (36%) in the laparoscopic group (P < 0.01). Bismuth type III or IV injuries were the commonest type in the laparoscopic cholecystectomy group (N = 25; 61%) while Bismuth type I or I I were the usual injuries in open cholecystectomy (N = 57; 69%) (P < 0.01). After hepaticojejunostomy, over a mean follow-up period of 3.4 years, sten osis of the hepaticojejunostomy was seen in two patients in both groups. Conclusion: Compared with open cholecystectomy, biliary injuries sustained during laparoscopic cholecystectomy are more likely to present earlier, are more often associated with persistent bile leaks, and are usually high inj uries. However, the results of surgical repair do not appear to be differen t in these two groups.