World Journal of Surgery

, Volume 40, Issue 1, pp 73–80 | Cite as

Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective

Original Scientific Report



Bile duct injury (BDI) is a rare complication associated with cholecystectomy, and recommendations for treatment are based on publications from referral centers with a selection of major injuries and failures after primary repair. The aim was to analyze the frequency, treatment, and outcome of BDIs in an unselected population-based cohort.


This was a retrospective cohort study including all BDIs registered in GallRiks (Swedish quality register for gallstone surgery and ERCP) during 2007–2011. Data for this study were based on a national follow-up survey where medical records were scrutinized and BDIs classified according to the Hannover classification.


A total of 174 BDIs arising from 55,134 cholecystectomies (0.3 %) identified at 60 hospitals were included with a median follow-up of 37 months (9–69). 155 BDIs (89 %) were detected during cholecystectomy, and immediate repair was attempted in 140 (90 %). A total of 27 patients (18 %) were referred to a HPB referral center. Hannover Grade C1 (i.e., small lesion <5 mm) dominated (n = 102; 59 %). The most common repair was “suture over T-tube” (n = 78; 45 %) and reconstruction with hepaticojejunostomy was performed in 30 patients (17 %). A total of 31 patients (18 %) were diagnosed with stricture, 19 of which were primarily repaired with “suture over T-tube.” The median in-hospital-stay was 14 days (1–149).


The majority of BDIs were detected during the cholecystectomy and repaired by the operating surgeon. Although this is against most current recommendations, short-term outcome was surprisingly good.



The authors wish to thank Anna Callmer and Nils Roubert who contributed by collecting and analyzing data from medical records of patients from the southern region of Sweden as part of the essay for their medical degree.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


This research was funded by Lund University, Region Skåne, grants from Eric and Angelicas Sparres Research foundation, Helge B Wulffs Research foundation, Professor Anders Borgströms Fellowship, and a travel grant from the Olympus Corporation.


  1. 1.
    Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125PubMedGoogle Scholar
  2. 2.
    Mjaland O, Adamsen S, Hjelmquist B, Ovaska J, Buanes T (1998) Cholecystectomy rates, gallstone prevalence, and handling of bile duct injuries in Scandinavia. A comparative audit. Surg Endosc 12(12):1386–1389PubMedCrossRefGoogle Scholar
  3. 3.
    Soderlund C, Frozanpor F, Linder S (2005) Bile duct injuries at laparoscopic cholecystectomy: a single-institution prospective study. Acute cholecystitis indicates an increased risk. World J Surg 29(8):987–993. doi:10.1007/s00268-005-7871-4 PubMedCrossRefGoogle Scholar
  4. 4.
    Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L (2003) Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 290(16):2168–2173PubMedCrossRefGoogle Scholar
  5. 5.
    Boerma D, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, Gouma DJ (2001) Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 234(6):750–757PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA Jr (1997) Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 225(3):268–273PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Andersson R, Eriksson K, Blind PJ, Tingstedt B (2008) Iatrogenic bile duct injury–a cost analysis. HPB (Oxford) 10(6):416–419CrossRefGoogle Scholar
  8. 8.
    Harboe KM, Anthonsen K, Bardram L (2009) Validation of data and indicators in the Danish Cholecystectomy Database. Int J Qual Health Care 21(3):160–168PubMedCrossRefGoogle Scholar
  9. 9.
    Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish Inpatient Registry. Arch Surg 141(12):1207–1213PubMedCrossRefGoogle Scholar
  10. 10.
    Tornqvist B, Stromberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Bektas H, Schrem H, Winny M, Klempnauer J (2007) Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 94(9):1119–1127PubMedCrossRefGoogle Scholar
  12. 12.
    Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, Talamini MA, Pitt HA, Coleman J, Sauter PA, Cameron JL (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241(5):786–792PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Fischer CP, Fahy BN, Aloia TA, Bass BL, Gaber AO, Ghobrial RM (2009) Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB (Oxford) 11(1):32–37PubMedCentralCrossRefGoogle Scholar
  14. 14.
    Stewart L, Way LW (2009) Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford) 11(6):516–522CrossRefGoogle Scholar
  15. 15.
    Pekolj J, Alvarez FA, Palavecino M, Sanchez Claria R, Mazza O, de Santibanes E (2013) Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 216(5):894–901PubMedCrossRefGoogle Scholar
  16. 16.
    Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW (2004) Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg 8(5):523–530PubMedCrossRefGoogle Scholar
  17. 17.
    Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 211:450CrossRefGoogle Scholar
  18. 18.
    Rystedt J, Montgomery A, Persson G (2014) Completeness and correctness of cholecystectomy data in a national register–Gallriks. Scand J Surg 103(4):237–244PubMedCrossRefGoogle Scholar
  19. 19.
    Perera MT, Silva MA, Hegab B, Muralidharan V, Bramhall SR, Mayer AD, Buckels JA, Mirza DF (2011) Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 253(3):553–560PubMedCrossRefGoogle Scholar
  20. 20.
    Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev 6:CD005641PubMedGoogle Scholar
  21. 21.
    Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database Syst Rev 6:CD005640PubMedGoogle Scholar
  22. 22.
    Scatton O, Meunier B, Cherqui D, Boillot O, Sauvanet A, Boudjema K, Launois B, Fagniez P, Belghiti J, Wolff P, Houssin D, Soubrane O (2001) Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg 233(3):432–437PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Mercado MA (2006) Early versus late repair of bile duct injuries. Surg Endosc 20(11):1644–1647PubMedCrossRefGoogle Scholar
  24. 24.
    Thomson BN, Parks RW, Madhavan KK, Wigmore SJ, Garden OJ (2006) Early specialist repair of biliary injury. Br J Surg 93(2):216–220PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Jenny Rystedt
    • 1
    • 2
  • Gert Lindell
    • 1
  • Agneta Montgomery
    • 1
  1. 1.Department of Surgery, Clinical SciencesLund UniversityLundSweden
  2. 2.Department of SurgerySkane University HospitalLundSweden

Personalised recommendations