Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat

BackgroundDespite improvement in the technique and increasing experience, complications of different nature and severity continue to occur during laparoscopic cholecystectomy all around the world. We present bile duct injuries in this series with regards to the incidence, severity and management of this problem.Study designDescriptive.Place and durationDepartment of surgery, Liaquat University of medical and Health Sciences, Jamshoro and other private hospitals at Hyderabad city during April 2003 to December 2007.Materials and methodsA total of 1132 patients with symptomatic gallstone disease were included in the study regardless of their age and gender. Laparoscopic cholecystectomy by classical four-port technique performed in all cases with few amendments as per situation. Patients with growth in gallbladder and with severe associated medical or cardiac problems were excluded from the study. Details of every patient collected on a proforma and data finally analyzed on SPSS version 10.ResultsOf total 1132 patients, 1088 (96%) were females and 44 (4%) were males with a mean age of 47.64 years. Elective laparoscopic cholecystectomy was performed in 1118 (98.7%) patients whereas emergency laparoscopic cholecystectomy was done in 14 (1.23%) patients. Various types of common bile duct injuries as well as post -operative bile leaks and their management is discussed with a view to improve upon the technique and out come.ConclusionIatrogenic biliary injuries continue to occur despite tremendous overall improvement in technique and expertise.