RESUMEN
Bile duct injuries were analysed in a prospective study of 1,250 cases of laparoscopic cholecystectomy. The aim of the study was to identify the incidence and causes of bile duct injuries in the course of laparoscopic cholecystectomy, and to recommend the possible ways to avoid this serious complication. Materials and Special computer forms were created to record detailed patient pre-operative, operative, and postoperative follow-up data for later study. Operative cholangiography was done only on a selective basis. Bile duct injuries were classified according to the Bismuth classification. Four cases [0.3%] of bile duct injuries were encountered in the study: 2 of them were classified as major [Bismuth classification grade II] and the other 2 as minor [diathermy puncture]. All injuries were attributed to distortion of Calot's triangle and failure to clearly identify the anatomy. A recent history of acute cholecystitis, a history of jaundice, pancreatitis and repeated or technically difficult endoscopic retrograde cholangiopancreatography [ERCP] were associated with local inflammatory changes that had possibly contributed to the distorted anatomy at Calot's triangle and consequently to the injury. All injuries were detected during surgery and immediately repaired. Major bile duct injuries were repaired by choledocho-enterotomy, while minor injuries were treated by simple sutures around the T tube in the common bile duct. All patients were asymptomatic with normal liver function tests on follow-up for a period up to 3 years after surgery. Conclusions: The incidence of bile duct injuries in laparoscopic cholecystectomy is comparable to open surgery. Patients with a clinical history of acute cholecystitis, or a recent history of jaundice and repeated ERCP should be considered for operative cholangiography in order to help reduce the chances of bile duct injuries