Iatrogenic bile duct injuries in the era of laparoscopic cholecystectomy: a single center experience

BACKGROUND: Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery and, with respect to the open approach, it represents the treatment of choice whose benefits are less postoperative pain, a shorter hospital stay and increased patient's satisfaction. However, it is associated with a higher incidence of bile duct injury than the open cholecystectomy. Iatrogenic bile duct injuries (IBDI) post-Videolaparoscopic cholecystectomy (LC) have been reported to occur with twice the incidence of an open cholecystectomy. These injuries should be identified intraoperatively or in the first period after surgery in order to assure low morbidity and reduce the risk of hepatic failure. METHODS: We led a single centered retrospective analysis of patients with diagnosis of IBDI sustained during Laparoscopic Cholecystectomy between July 1996 and September 2014. RESULTS: The results suggest that a high level of intra-operative diagnosis is possible and that the possibility of infra-operative repair of IBDI sustained during LC by experienced hepatobiliary surgeons is the most important factor to assure optimal results. CONCLUSIONS: When intra-operative treatment is not possible, it is imperative to refer the patients to a High-volume referral centre where a multidisciplinary team could assure the most adequate treatment.