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. 1999 Apr;229(4):449–457. doi: 10.1097/00000658-199904000-00001

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study.

D R Fletcher 1, M S Hobbs 1, P Tan 1, L J Valinsky 1, R L Hockey 1, T J Pikora 1, M W Knuiman 1, H J Sheiner 1, A Edis 1
PMCID: PMC1191728  PMID: 10203075

Abstract

BACKGROUND: Previous studies suggest that laparoscopic cholecystectomy (LC) is associated with an increased risk of intraoperative injury involving the bile ducts, bowel, and vascular structures compared with open cholecystectomy (OC). Population-based studies are required to estimate the magnitude of the increased risk, to determine whether this is changing over time, and to identify ways by which this might be reduced. METHODS: Suspected cases of intraoperative injury associated with cholecystectomy in Western Australia in the period 1988 to 1994 were identified from routinely collected hospital statistical records and lists of persons undergoing postoperative endoscopic retrograde cholangiopancreatography. The case records of suspect cases were reviewed to confirm the nature and site of injury. Ordinal logistic regression was used to estimate the risk of injury associated with LC compared with OC after adjusting for confounding factors. RESULTS: After the introduction of LC in 1991, the proportion of all cholecystectomy cases with intraoperative injury increased from 0.67% in 1988-90 to 1.33% in 1993-94. Similar relative increases were observed in bile duct injuries, major bile leaks, and other injuries to bowel or vascular structures. Increases in intraoperative injury were observed in both LC and OC. After adjustment for age, gender, hospital type, severity of disease, intraoperative cholangiography, and calendar period, the odds ratio for intraoperative injury in LC compared with OC was 1.79. Operative cholangiography significantly reduced the risk of injury. CONCLUSION: Operative cholangiography has a protective effect for complications of cholecystectomy. Compared with OC, LC carries a nearly twofold higher risk of major bile, vascular, and bowel complications. Further study is required to determine the extent to which potentially preventable factors contribute to this risk.

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Selected References

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  1. Adamsen S., Hansen O. H., Funch-Jensen P., Schulze S., Stage J. G., Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg. 1997 Jun;184(6):571–578. [PubMed] [Google Scholar]
  2. Bernard H. R., Hartman T. W. Complications after laparoscopic cholecystectomy. Am J Surg. 1993 Apr;165(4):533–535. doi: 10.1016/s0002-9610(05)80956-0. [DOI] [PubMed] [Google Scholar]
  3. Cagir B., Rangraj M., Maffuci L., Herz B. L. The learning curve for laparoscopic cholecystectomy. J Laparoendosc Surg. 1994 Dec;4(6):419–427. doi: 10.1089/lps.1994.4.419. [DOI] [PubMed] [Google Scholar]
  4. Cocks J., Johnson W., Cade R., Collopy B., Ewing H., Rogerson J., Rosengarten D., Thompson G., Turner P., Wale R. Bile duct injury during laparoscopic cholecystectomy: a report of the Standards Sub-committee of the Victorian State Committee of the Royal Australasian College of Surgeons. Aust N Z J Surg. 1993 Sep;63(9):682–683. doi: 10.1111/j.1445-2197.1993.tb00490.x. [DOI] [PubMed] [Google Scholar]
  5. Cohen M. M., Young W., Thériault M. E., Hernandez R. Has laparoscopic cholecystectomy changed patterns of practice and patient outcome in Ontario? CMAJ. 1996 Feb 15;154(4):491–500. [PMC free article] [PubMed] [Google Scholar]
  6. Davidoff A. M., Pappas T. N., Murray E. A., Hilleren D. J., Johnson R. D., Baker M. E., Newman G. E., Cotton P. B., Meyers W. C. Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg. 1992 Mar;215(3):196–202. doi: 10.1097/00000658-199203000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Deziel D. J., Millikan K. W., Economou S. G., Doolas A., Ko S. T., Airan M. C. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993 Jan;165(1):9–14. doi: 10.1016/s0002-9610(05)80397-6. [DOI] [PubMed] [Google Scholar]
  8. Fletcher D. R. Biliary injury at laparoscopic cholecystectomy: recognition and prevention. Aust N Z J Surg. 1993 Sep;63(9):673–677. doi: 10.1111/j.1445-2197.1993.tb00488.x. [DOI] [PubMed] [Google Scholar]
  9. Fletcher D. R. Laparoscopic cholecystectomy: what national benefits have been achieved and at what cost? Med J Aust. 1995 Nov 20;163(10):535–538. doi: 10.5694/j.1326-5377.1996.tb122142.x. [DOI] [PubMed] [Google Scholar]
  10. Fletcher DR. Operative Cholangiogram at Laparoscopic Cholecystectomy. Semin Laparosc Surg. 1995 Jun;2(2):111–117. doi: 10.1053/SLAS00200111. [DOI] [PubMed] [Google Scholar]
  11. Garden O. J. Iatrogenic injury to the bile duct. Br J Surg. 1991 Dec;78(12):1412–1413. doi: 10.1002/bjs.1800781203. [DOI] [PubMed] [Google Scholar]
  12. Hanney R. M., Alle K. M., Cregan P. C. Major vascular injury and laparoscopy. Aust N Z J Surg. 1995 Jul;65(7):533–535. doi: 10.1111/j.1445-2197.1995.tb01800.x. [DOI] [PubMed] [Google Scholar]
  13. Hunter J. G. Avoidance of bile duct injury during laparoscopic cholecystectomy. Am J Surg. 1991 Jul;162(1):71–76. doi: 10.1016/0002-9610(91)90207-t. [DOI] [PubMed] [Google Scholar]
  14. Jones R. M., Fletcher D. R., MacLellan D. G., Lowe A. W., Hardy K. J. Laparoscopic cholecystectomy: initial experience. Aust N Z J Surg. 1991 Apr;61(4):261–266. doi: 10.1111/j.1445-2197.1991.tb00208.x. [DOI] [PubMed] [Google Scholar]
  15. Larson G. M., Vitale G. C., Casey J., Evans J. S., Gilliam G., Heuser L., McGee G., Rao M., Scherm M. J., Voyles C. R. Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg. 1992 Feb;163(2):221–226. doi: 10.1016/0002-9610(92)90105-z. [DOI] [PubMed] [Google Scholar]
  16. Lorimer J. W., Fairfull-Smith R. J. Intraoperative cholangiography is not essential to avoid duct injuries during laparoscopic cholecystectomy. Am J Surg. 1995 Mar;169(3):344–347. doi: 10.1016/S0002-9610(99)80173-1. [DOI] [PubMed] [Google Scholar]
  17. McMahon A. J., Baxter J. N., O'Dwyer P. J. Preventing complications of laparoscopy. Br J Surg. 1993 Dec;80(12):1593–1594. doi: 10.1002/bjs.1800801233. [DOI] [PubMed] [Google Scholar]
  18. McMahon A. J., Fullarton G., Baxter J. N., O'Dwyer P. J. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg. 1995 Mar;82(3):307–313. doi: 10.1002/bjs.1800820308. [DOI] [PubMed] [Google Scholar]
  19. Moossa A. R., Mayer A. D., Stabile B. Iatrogenic injury to the bile duct. Who, how, where? Arch Surg. 1990 Aug;125(8):1028–1031. doi: 10.1001/archsurg.1990.01410200092014. [DOI] [PubMed] [Google Scholar]
  20. Olsen D. Bile duct injuries during laparoscopic cholecystectomy. Surg Endosc. 1997 Feb;11(2):133–138. doi: 10.1007/s004649900315. [DOI] [PubMed] [Google Scholar]
  21. Périssat J., Collet D., Belliard R., Desplantez J., Magne E. Laparoscopic cholecystectomy: the state of the art. A report on 700 consecutive cases. World J Surg. 1992 Nov-Dec;16(6):1074–1082. doi: 10.1007/BF02067064. [DOI] [PubMed] [Google Scholar]
  22. Richardson M. C., Bell G., Fullarton G. M. Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. West of Scotland Laparoscopic Cholecystectomy Audit Group. Br J Surg. 1996 Oct;83(10):1356–1360. doi: 10.1002/bjs.1800831009. [DOI] [PubMed] [Google Scholar]
  23. Russell J. C., Walsh S. J., Mattie A. S., Lynch J. T. Bile duct injuries, 1989-1993. A statewide experience. Connecticut Laparoscopic Cholecystectomy Registry. Arch Surg. 1996 Apr;131(4):382–388. doi: 10.1001/archsurg.1996.01430160040007. [DOI] [PubMed] [Google Scholar]
  24. Semmens J. B., Lawrence-Brown M. M., Fletcher D. R., Rouse I. L., Holman C. D. The Quality of Surgical Care Project: a model to evaluate surgical outcomes in Western Australia using population-based record linkage. Aust N Z J Surg. 1998 Jun;68(6):397–403. doi: 10.1111/j.1445-2197.1998.tb04786.x. [DOI] [PubMed] [Google Scholar]
  25. Windsor J. A., Vokes D. E. Early laparoscopic biliary injury: experience in New Zealand. Br J Surg. 1994 Aug;81(8):1208–1211. doi: 10.1002/bjs.1800810843. [DOI] [PubMed] [Google Scholar]
  26. Woods M. S., Traverso L. W., Kozarek R. A., Donohue J. H., Fletcher D. R., Hunter J. G., Oddsdottir M., Rossi R. L., Tsao J., Windsor J. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc. 1995 Oct;9(10):1076–1080. doi: 10.1007/BF00188990. [DOI] [PubMed] [Google Scholar]

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