7158 Frequency of laparoscopic cholecystectomy injuries detected at ercp: experience at a tertiary referral center.

Abstract

Background: Despite technical advances and increased surgical experience in laparoscopic cholecystectomy, bile duct leaks and injuries continue to be documented at ERCP. The aim of this on-going study was to review our ERCP experience to define the frequency and type of complications of laparoscopic cholecystectomy over the last 6 years. Methods: From 1/94 - 11/99, 107 patients (M:F 40:67; age range 18-91) were referred for postlaparoscopic cholecystectomy evaluation. Patients with post-laparoscopic cholecystectomy pain being evaluated for simple common bile duct stones and sphincter of Oddi dysfunction were excluded. Results: see Table. Summary: Our data suggest that complication rates following laparoscopic cholecystectomy are not decreasing. Conclusions: These data suggest an intrinsic risk associated with the laparoscopic approach which may not be overcome with greater experience. The role of referral bias, however, is unknown. An alternative interpretation is that injuries are declining overall, with more patients being referred to our tertiary referral center. Longterm follow-up of all patients undergoing laparoscopic cholecystectomy is necessary to determine the final procedure complication rate (i.e. lowgrade strictures with delayed clinical presentation). Background: Despite technical advances and increased surgical experience in laparoscopic cholecystectomy, bile duct leaks and injuries continue to be documented at ERCP. The aim of this on-going study was to review our ERCP experience to define the frequency and type of complications of laparoscopic cholecystectomy over the last 6 years. Methods: From 1/94 - 11/99, 107 patients (M:F 40:67; age range 18-91) were referred for postlaparoscopic cholecystectomy evaluation. Patients with post-laparoscopic cholecystectomy pain being evaluated for simple common bile duct stones and sphincter of Oddi dysfunction were excluded. Results: see Table. Summary: Our data suggest that complication rates following laparoscopic cholecystectomy are not decreasing. Conclusions: These data suggest an intrinsic risk associated with the laparoscopic approach which may not be overcome with greater experience. The role of referral bias, however, is unknown. An alternative interpretation is that injuries are declining overall, with more patients being referred to our tertiary referral center. Longterm follow-up of all patients undergoing laparoscopic cholecystectomy is necessary to determine the final procedure complication rate (i.e. lowgrade strictures with delayed clinical presentation).