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Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era

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Abstract

Background

Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate.

Methods

The National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI.

Results

The BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value < 0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value < 0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value < 0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value < 0.0001).

Conclusions

The performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.

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Authors and Affiliations

  1. Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA

    Christopher W. Mangieri, Bryan P. Hendren, Matthew A. Strode, Bradley C. Bandera & Byron J. Faler

  2. Roswell Park Cancer Institute, Buffalo, NY, USA

    Matthew A. Strode

  3. General Surgery Department, Dwight D. Eisenhower Army Medical Center (DDEAMC), 300 East Hospital Road, Fort Gordon, GA, 30905, USA

    Christopher W. Mangieri

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  1. Christopher W. Mangieri
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  2. Bryan P. Hendren
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Corresponding author

Correspondence to Christopher W. Mangieri.

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Disclosures

Drs. Christopher W. Mangieri, Bryan P. Hendren, Matthew A. Strode, Bradley C. Bandera, and Byron J. Faler have no conflicts of interest or financial ties to disclose.

Additional information

The main institution, Dwight D. Eisenhower Army Medical Center, is a participant member of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) and is authorized by the ACS to scientifically research and publish NSQIP data.

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Mangieri, C.W., Hendren, B.P., Strode, M.A. et al. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 33, 724–730 (2019). https://doi.org/10.1007/s00464-018-6333-7

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  • DOI: https://doi.org/10.1007/s00464-018-6333-7

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