Common bile duct injury after laparoscopic cholecystectomy: report of two cases

With a few exceptions, laparoscopic cholecystectomy has rapidly supplanted open cholecystectomy as the operation of choice for symptomatic cholelithiasis. The risk of bile duct injury using the laparoscopic technique is almost twice that of the open technique (0% to 1% vs 0% to 0.5%). There appears to be a direct correlation between the number of cases an individual surgeon performs and the frequency of bile duct injury. The nature of bile duct injuries following the laparoscopic technique tends to be more serious than those seen following the open procedure. In addition, more than 50% of bile duct injuries go undetected at the time of operation. A number of technical steps can be taken to help prevent bile duct injuries when using the laparoscopic technique. This article reports two such cases to alert the surgeon that a high index of suspicion must always be maintained concerning the possibility of bile duct injury following laparoscopic cholecystectomy.