Bile duct injury during laparoscopic cholecystectomy: Myth or reality of the learning curve?

• Published in: Surgical endoscopy Vol. 14; no. 7; pp. 608 - 611
• Main Authors: CALVETE, J, SABATER, L, CAMPS, B, VERDU, A, GOMEZ-PORTILLA, A, MARTIN, J, TORRICO, M. A, FLOR, B, CASSINELLO, N, LLEDO, S
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 2000
• Subjects: Adult; Aged; Bile Ducts - injuries; Biological and medical sciences; Cholecystectomy, Laparoscopic; Clinical Competence; Female; Humans; Intraoperative Complications - epidemiology; Intraoperative Complications - prevention & control; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Cholecystectomy; Human; Biliary tract; Endoscopic surgery; Professional experience; Iatrogenic; Laparoscopy; Biliary tract disease; Epidemiology; Incidence; Digestive diseases; Complication; Gallbladder; Lesion
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s004640000103

Bile duct injury (BDI) is a severe complication of laparoscopic cholecystectomy (LC) that is probably related to the effects of the learning curve. The aim of this prospective, institutional, and longitudinal study is to compare the incidence of BDI during LC in relation to the progressive experience of surgeons.
A total of 784 LC were examined during a 6-year period. They were divided into the following three consecutive groups: group A (1993-94), group B (1995-96), and group C (1997-98). Incidence and type of BDI, experience of the surgeon, intra- or postoperative diagnosis, treatment performed to repair the injury, and early and late morbidity and mortality were evaluated.
The overall incidence of BDI was 1.4%. There were three cases of transection of the common bile duct, four partial lesions of the bile duct, and four cystic leakages. The number of BDI was maintained over the three different time periods; there were no statistical differences in the proportion of injuries among groups. Most BDI were incurred by experienced surgeons. In all, 36% of BDI were recognized intraoperatively. Hepaticojejunostomy, direct suture over a T-tube, and closure of the cystic stump were done to repair BDI. There was no additional morbidity or mortality in the patients with BDI.
No relation was found between the experience of the surgeon and the number of BDI over the different periods of time. Therefore, BDI during LC cannot be attributed solely to the learning curve.