Iatrogenic Bile Duct Injury

Abstract

Hypothesis: Older age, male sex, and low yearly hospital volume of cholecystectomy may increase the risk of bile duct injury (BDI), whereas the use of intraoperative cholangiography may decrease the risk. The incidence of BDI at cholecystectomy may have increased after the introduction of laparoscopic cholecystectomy. Design: Nationwide population-based study of all cholecystectomies registered in the Swedish Inpatient Registry from 1987 through 2001. Setting: All hospitals performing inpatient cholecystectomies in Sweden. Patients: Cholecystectomies were identified using International Classification of Diseases, Ninth and 10th Revisions surgical procedure codes. After exclusion of patients with hepatobiliary and pancreatic malignancies, patients with codes indicating reconstructive bile duct operations within 1 year after cholecystectomy were considered BDI cases. Risk factors for BDI were analyzed using multivariate logistic regression. The incidence proportion of BDI was calculated by dividing the number of cases by the number of cholecystectomies. Main Outcome Measures: Relative risks were estimated using odds ratios with 95% confidence intervals, and incidence proportion was used to describe incidence. Results: Among 152 776 cholecystectomies, 613 reconstructed BDIs (0.40%) were identified. Older age and male sex were positively associated with BDI, whereas intraoperative cholangiography was negatively associated with BDI. The incidence proportion of BDI was 0.40% from 1987 to 1990, decreased to 0.32% from 1991 to 1995, and increased to 0.47% from 1996 to 2001. The mean yearly hospital volume did not affect the risk of BDI. Conclusions: Older age and male sex increased the risk of BDI, whereas intraoperative cholangiography was protective. There was a small to moderate long-term increase in the risk of BDI after the introduction of laparoscopic cholecystectomy compared with the prelaparoscopic era.

Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

“…Some large series, from individual institutions, have reported between a 0.1-0.4 % incidence of injury [20][21][22]. Our report, where BDI was measured by biliary reconstruction, is in agreement with the lowest rates, but they are not consistent with the highest rates reported over the last 10 years [23]. This could be attributed to our exclusion of minor BDIs not requiring biliary reconstruction and an inclusion of these same interventions in most other studies [20,24].…”

Optimal timing of preoperative indocyanine green administration for fluorescent cholangiography during laparoscopic cholecystectomy using the PINPOINT® Endoscopic Fluorescence Imaging System

“…Laparoscopic cholecystectomy is widely accepted as an effective treatment for benign gallbladder disease, but bile duct injury remains a serious complication, with an incidence of 0.3%–0.7% 1, 2, 3, 4, 5, 6. Bile duct injury is often caused by misinterpretation of the anatomical structures rather than by insufficient technical skills 7.…”

In Vivo Spectroscopic Characterization of Porcine Biliary Tract Tissues: First Step in the Development of New Biliary Tract Imaging Devices

“…As of yet, no technology has been developed that has the potential for eliminating this important surgical complication. Routine intraoperative cholangiography (IOC) has been advocated as a risk reduction strategy [5][6][7][8][9]25 but, at best, this can somewhat reduce but . Plot of the A, B and C coordinates for artery, vein and gallbladder following RBF fitting of the observed spectra.…”

“…This duct is buried under fatty tissues and cannot be visualized by the operating surgeon. Although only occurring in about 0.5% of cases, 8,[21][22][23]25 bile duct injury (BDI) can occur and when it does, have devastating consequences. 2,6,10,12,19 In an era where surgeon-induced injury is not acceptable, a pressing need exists for developing technologies to minimize or eliminate the risk for these injuries by providing a means for surgeons to locate these ducts during surgery.…”