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- Title
Iatrogenic bile duct injuries.
- Authors
Savassi-Rocha, P. R.; Almeida, S. R.; Sanches, M. D.; Andrade, M. A. C.; Frerreira, J. T.; Diniz, M. T. C.; Rocha, A. L. S.
- Abstract
<bold>Background: </bold>The real incidence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not known.<bold>Methods: </bold>Using questionnaires, we analyzed 91,232 LC performed by 170 surgical units in Brazil between 1990 and 1997.<bold>Results: </bold>A total of 167 BDI occurred (0.18%); the most frequent were Bismuth type 1 injuries (67.7%). Most injuries (56.8%) occurred at the hands of surgeons who had surpassed the learning curve (50 operations). However, the incidence dropped with increasing experience; it was 0.77% at surgical departments with <50 operations vs 0.16% at departments with >500 operations. The diagnosis was made intraoperatively in 67.7%, but it was based on intraoperative cholangiography in only 19.5%. The procedure was converted to open surgery in 85.8% when the diagnosis of injury occurred intraoperatively, and laparotomy was performed in 90.7% when the injury was diagnosed postoperatively. The mean hospitalization time was 7.6 +/- 5.9 days, the major complications were stenosis and fistulas, and the mortality rate was 4.2%.<bold>Conclusion: </bold>The incidence of BDI after LC is similar to that reported for the open procedure. BDI increases mortality and morbidity and prolongs hospitalization; therefore, all efforts should be made to reduce its incidence.
- Subjects
BILE ducts; CHOLECYSTECTOMY; ENDOSCOPIC surgery; LAPAROSCOPIC surgery; IATROGENIC diseases; SURGEONS; WOUNDS &; injuries
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2003, Vol 17, Issue 9, p1356
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-002-8726-9