Common bile duct injuries during laparoscopic cholecystectomy

Iatrogenic common bile duct injuries are the worst complication of laparoscopic cholecystectomy. The goal of this study is to increase awareness of the problem and educate surgeons about the consequences and proper management of these injuries. Cholecystectomy is the most common gastrointestinal operation performed. Laparoscopic cholecystectomy was first performed by Erich Muhe in 1985 in Germany. In 1987 laparoscopically complete removal of GB was performed by Mourat in Lyon, France. The widespread acceptance of laparoscopic cholecystectomy was based on anticipated reduction in postoperative pain, minimal tissue injury intraoperatively and early return to work. It has now become a gold standard for the treatment for GB stone in experience and safe hand. Many articles source that soon after introduction, how it became clear that laparoscopic cholecystectomy was associated with unique complication of higher rate of CBD injures compared with open cholecystectomy. Highest rates of CBD injuries where reported in early 1990s when laparoscopic cholecystectomy was introduced, suggesting a learning curve effect. In a review by Strasburg et al and Roslyl et al, the incidence of billiary injuries during open cholecystectomy was found 0.2-0.3%. The review by Strasburg et al in 1995 of more than 124000 laparoscopic cholecystectomies reported in literature found the incidence of major bile duct injuries to be 0.5%. Even as the surgeon passed through learning curve and has reached “steady-state” and there has been no significant improvement in the incidence of billiary duct injuries. The impact of major CBD injuries is staggering to both the patient and health care system.