World Journal of Surgery

, Volume 40, Issue 5, pp 1060–1067 | Cite as

Severity of Acute Cholecystitis and Risk of Iatrogenic Bile Duct Injury During Cholecystectomy, a Population-Based Case–Control Study

  • Björn TörnqvistEmail author
  • Anne Waage
  • Zongli Zheng
  • Weimin Ye
  • Magnus Nilsson
Original Scientific Report



Acute cholecystitis is a common complication to gallstone disease. The relation between the severity of acute cholecystitis and risk of bile duct injury during cholecystectomy has not yet been addressed and is the main focus of this study.


All cases with iatrogenic bile duct injury during cholecystectomy, within the Lake Mälaren region, Sweden, were identified through ICD procedure codes for biliary reconstruction within the Swedish Inpatient Register and matched to non-injured cholecystectomized controls. Information regarding perioperative variables was collected through medical record review.


After review, 158 cases and 623 controls remained for analyses. Adjusted risk of bile duct injury was doubled among patients with acute cholecystitis (OR 1.97 95 % CI 1.05–3.72), whereas a mild acute cholecystitis (Tokyo grade I) did not affect the risk of bile duct injury (OR 0.96 95 % CI 0.41–2.25), a moderate (Tokyo grade II) more than doubled the risk (OR 2.41 95 % CI 1.21–4.80). Severe cholecystitis (Tokyo grade III) had a close to significant eightfold increase in risk (OR 8.43 95 % CI 0.97–72.9). The intention to use intraoperative cholangiography reduced injury risk by 52 % (OR 0.48, 95 % CI 0.29–0.81).


Patients with on-going acute cholecystitis had twice the risk of sustaining a biliary lesion compared to patients without acute cholecystitis. There was a relation between the Tokyo guidelines severity grading of acute cholecystitis and injury risk and the intention to use intraoperative cholangiography halved the risk of reconstructed bile duct injury during cholecystectomy.


Cholecystitis Acute Cholecystitis Bile Duct Injury Acute Cholangitis Biliary Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Grant support

Research Grants from Karolinska Institutet were used for the Project

Compliance with Ethical Standard

Conflict of interest

The authors disclose no conflicts of interest


The study was approved by the Regional Research Ethics Committee of Stockholm, reference number 04-139/3


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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Björn Törnqvist
    • 1
    Email author
  • Anne Waage
    • 2
  • Zongli Zheng
    • 3
  • Weimin Ye
    • 3
  • Magnus Nilsson
    • 1
  1. 1.Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska University HospitalKarolinska InstitutetStockholmSweden
  2. 2.Department of SurgeryOslo University HospitalOsloNorway
  3. 3.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden

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