Online citations, reference lists, and bibliographies.

The Dramatic Reality Of Biliary Tract Injury During Laparoscopic Cholecystectomy

J.-F. Gigot, J. Etienne, R. Aerts, E. Wibin, B. Dallemagne, F. Deweer, D. Fortunati, M. Legrand, L. Vereecken, J. Doumont, P. van Reepinghen, C. Beguin
Published 1997 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
AbstractBackground: Most reports concerning the outcome of patients with biliary tract injury during laparoscopic cholecystectomy come from tertiary referral centers, and results could be very different in the everyday practice of community surgeons. Objective: The objective is to define the presentation, mechanisms, results of treatment, and long-term outcome of biliary tract injuries during laparoscopic cholecystectomy in the setting of a community surgeon's practice. Methods: An anonymous retrospective multicenter survey of 9,959 patients who underwent laparoscopic cholecystectomy was conducted by the Belgian Group for Endoscopic Surgery, composed mainly of community general surgeons. Results: Sixty-five patients with bile duct injury were reported on; the incidence was 0.5%, varying from 0.35 to 1.3% according to the experience of the surgeon. Thirty-four percent of ductal injuries occurred with experienced surgeons, often in association with local predisposing risk factors. Injury occurred in 87% of cases during dissection of the Calot triangle, with severe injury occurring in 46% of patients. Intraoperative cholangiography was performed in 34% of patients and was associated with a significantly improved operative detection rate of injury (68% vs 32%, p= 0.007). Operative detection of injury occurred in 45% of patients; diffuse bile ascitis was encountered postoperatively in 29%. The overall mortality was 9%, the postoperative biliary complication rate 31%, and the reintervention rate 14%. During a median follow-up of 49 months (range, 3–78 months), 20 of the 61 surviving patients (33%) had recurrent biliary strictures. Multivariate analysis demonstrated that the age of the patient (odds ratio: 0.893) and the presence of biliary peritonitis (odds ratio: 0.061) were independent predictive factors for mortality and that the age of the patient (odds ratio: 1.049) and the occurrence of postoperative biliary complications (odds ratio: 0.161) after the initial biliary repair were independent predictive factors for late biliary stricture. Conclusions: Biliary tract injury is associated with significant mortality and complications in the practice of Belgian community surgeons. Intraoperative detection of ductal injury by the routine use and a correct interpretation of intraoperative cholangiography improved outcome. The impact of the primary biliary repair on long-term outcome is an argument to refer these patients to specialized multidisciplinary experts. The results highlight the importance of surgical experience, proper selection of patients for laparoscopic cholecystectomy, and conversion to laparotomy in difficult cases.
This paper references
Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group.
J. Barkun (1992)
Avoidance of bile duct injury during laparoscopic cholecystectomy.
J. Hunter (1991)
Laparoscopic Cholecystectomy: A Statewide Experience
R. Orlando (1993)
Mechanisms of major biliary injury during laparoscopic cholecystectomy
R. Lev (1992)
Gallstones and Laparoscopic Cholecystectomy
J. Gollan (1993)
Correction: A prospective analysis of 1518 laparoscopic cholecystectomies.
J. Barone (1991)
Strategies for the prevention of laparoscopic common bile duct injuries
K. Horvath (1993)
Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases.
D. Deziel (1993)
Coelioscopic Cholecystectomy: Preliminary Report of 36 Cases
F. Dubois (1990)
Open Cholecystectomy A Contemporary Analysis of 42,474 Patients
J. Roslyn (1993)
Intraoperative cholangiography is not essential to avoid duct injuries during laparoscopic cholecystectomy.
J. Lorimer (1995)
Diagnosis and management of biliary complications of laparoscopic cholecystectomy.
N. Soper (1993)
Spectrum and management of major complications of laparoscopic cholecystectomy.
A. Ress (1993)
Laparoscopic cholecystectomy bile duct injuries: more than meets the eye.
P. C. Rantis (1993)
3606 cholecystectomies sous coelioscopie : registre de la Socie ́ téFrançaise de Chirurgie Digestive
B Suc (1992)
Laparoscopic cholecystectomy in the Netherlands
P. Go (1993)
Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy?
G. Berci (1991)
Laparoscopic cholecystectomy : the Belgian registry
E Vincent-Hamelin (1992)
Postoperative strictures of the bile duct. In: Blumgart LH (ed) The biliary tract
H Bismuth (1982)
National survey on laparoscopic cholecystectomy in Spain
E. Vincent-Hamelin (1994)
Bile duct injuries, 1989-1993. A statewide experience. Connecticut Laparoscopic Cholecystectomy Registry.
J. Russell (1996)
Laparocholecystectomy. 6,865 cases from Italian institutions.
E. Croce (1994)
Laparoscopic bile duct injuries. Risk factors, recognition, and repair.
R. L. Rossi (1992)
Complications des chole ́ cystectomies par voie coelioscopique : a ` propos de 6512 observations
B Delaitre (1992)
Laparoscopic cholecystectomy: the Austrian experience.
Wolfgang Ulf Wayand (1993)
Complications des chole ́cystectomies par voie coelioscopique: a ` propos de 6512
B Delaitre (1992)
Bile duct injury in laparoscopic cholecystectomy.
C. M. Ferguson (1992)
Management of Major Biliary Complications After Laparoscopic Cholecystectomy
G. Branum (1993)
Bile duct injuries, 1989-1993 : A statewide experience. Discussion
J. C. Russell (1996)
Laparoscopie Injuries to the Bile Duct: A Cause for Concern
A. Moossa (1992)
Characteristics of biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study.
M. Woods (1994)
The learning curve for laparoscopic cholecystectomy
M. Moore (1995)
Bile duct injury during laparoscopic cholecystectomy: Mechanism of injury, prevention, and management
H. Asbun (2005)
Twelve hundred open cholecystectomies before the laparoscopic era. A standard for comparison.
L. Morgenstern (1992)
A nation’s experience in laparoscopic cholecystectomy
R. Schlumpf (1994)
Postoperative strictures of the bile ducts--causes, prevention, repair procedures.
R. Maingot (1977)
Bile duct injury and bile leakage in laparoscopic cholecystectomy
S. Huang (1993)
Laparoscopic treatment, intracorporeal lithotripsy followed by cholecystectomy or cholecystectomy-a personal technique
Jacques Périssat (1989)
Bile duct injury during laparoscopic and conventional cholecystectomy.
D. Gouma (1994)
Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors.
P. Clavien (1992)
Conversions and complications of laparoscopic cholecystectomy
D. Collet (1993)
The E.A.E.S. Consensus development conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair
E. A. M. Neugebauer (2004)

This paper is referenced by
Bile duct injury during cholecystectomy and survival in medicare beneficiaries.
D. Flum (2003)
A survey of the accuracy of interpretation of intraoperative cholangiograms.
P. Sanjay (2012)
Choledocholithiasis, endoscopic retrograde cholangiopancreatography, and laparoscopic common bile duct exploration.
M. Kroh (2008)
Identification, Classification, and Management
Lygia Stewart (2014)
Incidence, Risk Factors, and Prevention of Biliary Tract Injuries during Laparoscopic Cholecystectomy in Switzerland
L. Krähenbühl (2001)
Expérience de la cholangiographie peropératoire systématique au cours de la cholécystectomie laparoscopique
E. Capelluto (1999)
Clipless laparoscopic cholecystectomy by ultrasonic dissection.
S. Bessa (2008)
Bile Duct Injury during Laparoscopic Cholecystectomy: Risk Factors, Mechanisms, Type, Severity and Immediate Detection
J. Gigot (2003)
Iatrogenic biliary injuries: classification, identification, and management.
K. McPartland (2008)
Proyecto Nacional para la Gestión Clínica de Procesos Asistenciales. Tratamiento quirúrgico de la colelitiasis. Desarrollo de la vía clínica
R. Plaza (2006)
Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy
C. Halbert (2016)
Traitement des complications de la cholécystectomie
Laurent Chiche (2010)
Right hepatic lobectomy for recurrent cholangitis after combined bile duct and right hepatic artery injury during laparoscopic cholecystectomy: a report of two cases
S. Schmidt (2002)
Laparoscopic Cholecystectomy: Bile Duct and Vascular Injuries: Management and Outcome
Ø. Mathisen (2002)
Estado actual de la colecistectomía laparoscópica
Elías Chousleb Mizrahi (2004)
Risk Factors for Bile Duct Injury During Laparoscopic Cholecystectomy: A Case-Control Study
Ramin Kholdebarin (2008)
An ergonomic analysis of the effects of camera rotation on laparoscopic performance
A. Gallagher (2008)
Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions
K. T. Buddingh (2011)
Triangle of Safety Technique: A New Approach to Laparoscopic Cholecystectomy
Abdulrahman Faraj Almutairi (2009)
Adénomyomatose vésiculaire : diagnostic et prise en charge
Nicolas Golse (2017)
Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes.
Z. V. Fong (2018)
The Cost and the Effectiveness of Cholangiography for the Diagnosis and Treatment of a Bile Duct Injury After Difficult Identification of the Cystic Duct
Frédéric Borie (2020)
Epidemiology of Bile Duct Injury
Vinay Kumar Kapoor (2020)
Who oversees innovative practice? Is there a structure that meets the monitoring needs of new techniques?
S. Strasberg (2003)
Predicting gangrenous cholecystitis.
B. Wu (2014)
Surgical outcomes of laparoscopic cholecystectomy in scleroatrophic gallbladders.
Musa Akoğlu (2011)
For patients with predicted low risk for choledocholithiasis undergoing laparoscopic cholecystectomy, selective intraoperative cholangiography and postoperative endoscopic retrograde cholangiopancreatography is an effective strategy to limit unnecessary procedures
Michael F. Byrne (2008)
Fundamentals of Surgical Simulation
A. Gallagher (2012)
Kapitel 1 – Cholezystektomie
B. Navez (2007)
Frequency of complications due to laparoscopic cholecystectomy in Hamedan Hospitals.
Derakhshanfar Amir (2012)
Ethique de la recherche appliquée à la chirurgie : Evaluation de la protection des personnes et de l’intégrité scientifique dans la recherche en chirurgie
Valérie Huybrechts (2012)
Post-cholecystectomy Bile Duct Injury
Matthew P. Lungren (2020)
See more
Semantic Scholar Logo Some data provided by SemanticScholar