Bile duct injury during laparoscopic cholecystectomy, 1997 – 2002 A multicenter study of 201 bile duct injuries in 31,000 operations in Japan *
Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is still one of the most serious complications of this procedure. An investigation involving a large number of cases has yet to be performed in Japan. Therefore, we carried out a retrospective multicenter study to assess the incidence and characteristics of BDI in Japan. A questionnaire structured to focus on BDI during LC was sent to 233 hospitals affiliated with the Japanese Society of Biliary Surgery. It included: the number of LC’s during a five year period (from 1997 to 2002), the number of BDI’s, gender, age, preoperative diagnosis, site and type of injury, Strasberg’s classification, suspected cause, timing of diagnosis, primary treatment, secondary or further treatment, and prognosis in patients with BDI during LC. Two hundred and one cases of BDI amongst 31,000 LC’s were reported with the incidence being 0.65%. Of the 201 patients, 96 were male and 106 were female, the average age was 56.5 years old. Cholecystolithiasis and cholecystitis were the operative indications in 89.1%. Regarding the site of injury, the common bile duct was involved in 44.8% and the common hepatic duct in 21.9%. As for the type of injury, partial injury occurred in 56.7% and transaction in 33.8%. Type D injury was the most frequent (44.8%), followed by type E2 injuries (16.4%) according to Strasberg’s classification. Severe inflammation and misidentification were the two most common causes. Although two thirds of the BDI’s were diagnosed intraoperatively, sixty BDI’s (29.9%) were diagnosed postoperatively. The primary treatment was open surgery in 71.1% of the cases. Laparoscopic treatment was carried out for 18.4% and non-operative treatment was used for 9.5%. Thirty patients (14.9%) required second or further procedures including open surgery, laparoscopic surgery, or radiological interventions. The overall mortality rate in LC was 0.016% and the mortality rate after BDI was 2.5%. The incidence and mortality of BDI in Japan were found to be similar to those in other Western national surveys. Misidentification could be avoided with more surgical experience and the use of the correct techniques. Delayed diagnosis should be reduced with meticulous follow up after LC. (Accepted on April 13, 2012)
