Bile Duct Injury During Laparoscopic Cholecystectomy - a Preventable Issue?

Abstract

Laparoscopic cholecystectomies (LCs) are the current gold standard treatment for gallstone disease. However, iatrogenic bile duct injury (IBDI) is a well-documented complication that significantly raises morbidity, mortality, length of hospitalisation, and financial costs. With the popularisation of LCs in the 1990s the incidence of IBDIs went up from 0.1-0.5% in open procedures to 3% in LCs. With an increasing amount of surgical experience, academic literature, and widespread recognition of the issue, the prevalence of IBDIs in the modern era is falling but they still occur with serious consequences. This report presents a case of an elective LC with iatrogenic common bile duct (CBD) injury that was repaired with a Roux-en-Y hepaticojejunostomy that was later complicated by anastomotic leak and sepsis. It will go on to review the evidence addressing why this happens and how best to prevent it, before briefly touching on management and associated complications.