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Iatrogenic bile duct injuries
P R Savassi-Rocha1, S R Almeida, M D Sanches
1Alfa Institute of Gastroenterology, University Hospital, Federal University of Minas Gerais, 110 Alfredo Balena Ave., Belo Horizonte, MG, 30.220-260, Brazil. psavassi@medicina.ufmg.br
Background:
The real incidence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not known.
Methods:
Using questionnaires, we analyzed 91,232 LC performed by 170 surgical units in Brazil between 1990 and 1997.
Results:
A total of 167 BDI occurred (0.18%); the most frequent were Bismuth type 1 injuries (67.7%). Most injuries (56.8%) occurred at the hands of surgeons who had surpassed the learning curve (50 operations). However, the incidence dropped with increasing experience; it was 0.77% at surgical departments with <50 operations vs 0.16% at departments with >500 operations. The diagnosis was made intraoperatively in 67.7%, but it was based on intraoperative cholangiography in only 19.5%. The procedure was converted to open surgery in 85.8% when the diagnosis of injury occurred intraoperatively, and laparotomy was performed in 90.7% when the injury was diagnosed postoperatively. The mean hospitalization time was 7.6 +/- 5.9 days, the major complications were stenosis and fistulas, and the mortality rate was 4.2%.
Conclusion:
The incidence of BDI after LC is similar to that reported for the open procedure. BDI increases mortality and morbidity and prolongs hospitalization; therefore, all efforts should be made to reduce its incidence.