Skip to main content
SpringerLink
Log in

Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Biliary injuries during laparoscopic cholecystectomy (LC) are complications better avoided than treated. These injuries cause long-lasting morbidity and can be fatal. The authors present their experience with biliary injury in LC during a period exceeding 13 years.

Methods

Between January 1992 and December 2005, 13,305 LCs were performed at the authors’ institution. The biliary injuries in these cases were recorded and analyzed retrospectively.

Results

A total of 52 biliary injuries were identified in 13,305 LCs, for an overall incidence of 0.39%. Of these, 32 (0.24%) were diagnosed intraoperatively and 20 (0.15%) were diagnosed postoperatively. The perioperative bile duct injuries (BDIs) included 6 complete transections (5 treated by hepaticojejunostomy and 1 by primary T-tube repair (TTR), all performed by conversion to open procedure), 11 lateral BDIs (2 treated by laparoscopic choledochojejunostomy [CJ], 1 by open CJ, 5 by laparoscopic TTR, 1 by open TTR, and 2 by primary suture repair, both performed laparoscopically), 11 duct of Luschka injuries, and 4 sectoral duct injuries. The BDIs detected postoperatively included 6 patients with bilioma (treated with ultrasonography-guided aspiration), 4 patients with biliary peritonitis (requiring relaparoscopy and peritoneal lavage and drainage followed by endoscopic retrograde cholangiography [ERC] and biliary stenting), and 10 patients with persistent biliary leak-controlled biliary fistula (requiring ERC and stenting). There was no mortality related to BDI in the series. Patients with Strasberg type A/C/D injuries (46 cases) were followed 3 months to 3 years with no major complaints. Two patients with complete transection were lost to follow-up evaluation, whereas the other four patients, followed 18 months to 3 years, were asymptomatic.

Conclusions

According to the findings, LC is a safe procedure with an incidence of biliary injury comparable with that for open cholecystectomy. Single-center studies such as this are important to ensure that standards of surgery are maintained in the community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Langenbuch CJA (1882) Ein Fall von Exterpation Gallenblase wegen chroischer Cholelithisasis:Heilung. Berl Klin Wochenschr 19:725–727

    Google Scholar 

  2. Mouret P (1991) From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the prospective future. Dig Surg 8:124–125

    Article  Google Scholar 

  3. Calvete J, Sabater L, Camps B, Verdu A, Gomez-Portilla A, Martin J, Torrico MA, Flor B, Cassinello N, Lledo S (2000) Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve? Surg Endosc 14:608–611

    Article  PubMed  CAS  Google Scholar 

  4. Waage A, Nilsson M (2006) A population-based study of 152,776 cholecystectomies in the Swedish inpatient registry. Arch Surg 141:1207–1213

    Article  PubMed  Google Scholar 

  5. Ooi LLPJ, Goh YC, Chew SP, Tay KH, Foo E, Low CH, Ch’Ng HC, Chan STS, Soo KC (1999) Bile duct injuries during laparoscopic cholecystectomy: a collective experience of four teaching hospitals and results of repair. Aust N Z J Surg 69:844–846

    Article  PubMed  CAS  Google Scholar 

  6. Windsor JA, Pong J (1998) Laparoscopic biliary injuries: more than a learning curve problem. Aust N Z Surg 68:186–189

    Article  CAS  Google Scholar 

  7. Adamsen S, Hansen OH, Funch-Jenson P, Schulze S, Satge JG, Wara P (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg; 184:571–578

    PubMed  CAS  Google Scholar 

  8. Fletcher DR, Hobb MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risk of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229:449–457

    Article  PubMed  CAS  Google Scholar 

  9. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

    PubMed  CAS  Google Scholar 

  10. Rosolyn JJ, Binn GS, Hughes EF, Saunders – Kirkwood K, Zinner MJ, Cates JA (1993) Open cholecystectomy: a contemporary analysis of 42,474 patients. Ann Surg 218:129–137

    Article  PubMed  CAS  Google Scholar 

  11. Savader ST, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA (1997) Laparoscopic cholecystectomy–related bile duct injuries: a health and financial disaster. Ann Surg 225:268–273

    Article  PubMed  CAS  Google Scholar 

  12. Z’graggen K, Wherli H, Metzger A, Buehler M, Frie E, Klaiber C (1998) Complications of laparoscopic cholecystectomy in Switzerland. a proscective 3-year study of 10,174 patients. Swiss Assosiation of Laparoscipic and Thoracoscipic Surgery. Surg Endosc 12:1303–1310

    Article  PubMed  CAS  Google Scholar 

  13. Karvonen J, Gullichsen R, Laine S, Salminen P, Groonroos J (2007) Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. Surg Endosc 21:1069–1073

    Article  PubMed  Google Scholar 

  14. Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA (1997) Laparoscopic cholecystectomy bile duct injuries: a health and financial disaster. Ann Surg 225:268–273

    Article  PubMed  CAS  Google Scholar 

  15. Nuzzo G, Giuliante F, Glovannini I, Ardito F, D’Acapito F, Vellone M, Murazio M, Capelli G (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56,591 cholecystectomies. Arch Surg 140:986–992

    Article  PubMed  Google Scholar 

  16. Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 184:571–578

    PubMed  CAS  Google Scholar 

  17. David R, Flum E, Dellinger P, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289:1639–1644

    Article  Google Scholar 

  18. Olsen D (1997) Bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 11:133–138

    Article  PubMed  CAS  Google Scholar 

  19. Chaudhary A, Manisegran M, Chandra A, Agarwal AK, Sachdev AK (2001) How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy? J Laparoendosc Adv Surg Tech 11:187–191

    Article  CAS  Google Scholar 

  20. Wherry DC, Marohn MR, Malanoski MP, Hetz S, Rich NM (1996) An external audit of laparoscopic cholecystectomy in the steady state performed in medical treatment facilities of the Department of Defense. Ann Surg 224:145–154

    Article  PubMed  CAS  Google Scholar 

  21. Zvonimir P, Tomislav K, Bjorn DF, Hrvoje H, Aljosa M, Miroslav BB (2003) Bile duct injuries during open and laparoscopic cholecystectomy at Sestre Milosrdnice University Hospital from 1995 till 2001. Acta Clin Croat 42:217–223

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Minimal Access Surgery, ILS Multispeciality Clinic, DD-6, Sector – I, Salt Lake City, Kolkata, 700 064, India

    O. Tantia, M. Jain, S. Khanna & B. Sen

Authors
  1. O. Tantia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Khanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Sen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Tantia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tantia, O., Jain, M., Khanna, S. et al. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg Endosc 22, 1077–1086 (2008). https://doi.org/10.1007/s00464-007-9740-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9740-8

Keywords

Search

Navigation