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Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends

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Abstract

Background

After the introduction of laparoscopic cholecystectomy (LC), scientific discussion and concern about iatrogenic bile duct injuries (BDIs) have been limited mostly to BDIs sustained in LC, while BDIs sustained in open cholecystectomy (OC) and in all cholecystectomies have not been the center of attention.

Methods

This study included all patients who sustained BDI in OC or LC in southwest Finland between 1997 and 2007. All data were collected retrospectively in June 2009.

Results

Altogether 75 BDIs were encountered in a total of 8349 cholecystectomies, for an overall incidence of 0.90%. Twenty BDIs (15 Amsterdam type A and 5 type B, C, or D) occurred in the 1616 OCs (incidence rate = 1.24%), and 55 (26 type A and 29 type B, C, or D) in the 6733 LCs (incidence rate = 0.82%). All the BDIs in the OCs were missed while 11/29 of the major BDIs in the LCs were detected at the time of surgery. Fifty-four of 59 type A, B, and C BDIs could be treated endoscopically.

Conclusions

In the laparoscopic era, OC is associated with a high number of BDIs, if minor BDIs are included. Excluding some major LC BDIs, BDIs are, as a rule, missed at the time of surgery. More than 90% of Amsterdam types A, B, and C BDIs can be treated endoscopically, whereas type D BDI remains an absolute indication for surgery.

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Disclosures

Jukka Karvonen, Paulina Salminen, and Juha M. Grönroos have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Loimaa District Hospital, Seppälänkatu 15-17, PB 17, 32201, Loimaa, Finland

    Jukka Karvonen

  2. Department of Surgery, University of Turku, Turku, Finland

    Paulina Salminen & Juha M. Grönroos

  3. Department of Emergency, University of Turku, Turku, Finland

    Juha M. Grönroos

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  1. Jukka Karvonen
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  2. Paulina Salminen
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Correspondence to Jukka Karvonen.

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Karvonen, J., Salminen, P. & Grönroos, J.M. Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends. Surg Endosc 25, 2906–2910 (2011). https://doi.org/10.1007/s00464-011-1641-1

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  • DOI: https://doi.org/10.1007/s00464-011-1641-1

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