An analysis of bile duct injuries during laparoscopic cholecystectomy

Thirty-seven cases (0.86%) of bile duct injuries during laparoscopic cholecystectomy performed at the 1st Department of Surgery, Okayama University Medical School and 13 other hospitals were evaluated. Sites of the injuries included 33 cases of common bile/hepatic duct, 2 of liver bed. 1 of posterior branch, and 1 of caudate branch. Eighteen cases (49%) occurred at hospitals performing less than 100 laparoscopic cholecystectomies, and 22 cases (59%) resulted from surgeons who performed less than 20 laparoscopic cholecystectomies. These results suggest that a lack of experience caused bile duct injuries. In cases with inflammation, evaluation of inflammatory degree by preoperative imaging may be important to avoid injuries due to misidentification. In these cases, it is essential to convert to open cholecystectomy without sticking on laparoscopic procedure. In order to avoid electrocautery injuries, the instrument should be used close to the wall of the gall bladder and should not be used near the bile duct. Futher, intraoperative cholangiography is useful to detect intraoperatively bile duct injuries.