Bile duct injuries, 1989-1993. A statewide experience. Connecticut Laparoscopic Cholecystectomy Registry
J. C. Russell, S. J. Walsh, A. S. Mattie and J. T. Lynch
Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Wallingford, USA.
OBJECTIVE: To review the incidence of major bile duct injuries (MBDI)
during the shift from open (OC) to laparoscopic cholecystectomy (LC).
DESIGN: Cohort analysis; minimum 15-month patient follow-up. SETTING: Acute
care Connecticut hospitals. PATIENTS: Medical records of 30211 patients
with cholecystectomy (OC or LC) reviewed; 47 cases of MBDI confirmed. MAIN
OUTCOME MEASURE: Rate of MBDI. RESULTS: The incidence of MBDI in
Connecticut hospitals rose from 0.04% in 1989 to 0.24% in 1991, then
decreased to 0.11% in 1993. The increase was due to increased numbers of
cholecystectomies and the initial increased risk of injury with LC. The
1990-through-1993 trend of decreasing incidence of LC MBDI was
statistically significant (P=.02). By 1993, the difference between LC and
OC was no longer significant (P=.81). Acute cholecystitis (odds ratio, 3.3)
and gallstone pancreatitis (odds ratio, 3.6) increased the risk of MBDI
during LC (P<.001). The LC MBDI more commonly were ductal excision or
transections and often were not diagnosed intraoperatively. Intraoperative
cholangiography facilitated intraoperative recognition and repair. Most
patients (89%) underwent definitive management of the MBDI at the hospital
of origin; of those, 5% required further interventions. CONCLUSIONS:
Surgeries for acute cholecystitis and gallstone pancreatitis are associated
with an increased risk for MBDI. Ductal anatomy, the timing of recognition
of injury, and the method of repair dictate patient outcomes. Most patients
are successfully managed at the hospital of origin, with good long-term
results. Late bile duct strictures appear rare.
