Bile duct injury and use of cholangiography during laparoscopic cholecystectomy

Background: Bile duct injury (BDI) remains the most serious complication of laparoscopic cholecystectomy (LC). A Swiss database was used to identify risk factors for BDI and to assess the effect of intraoperative cholangiography (IOC). Methods: Data for patients from 114 Swiss institutions who underwent LC for acute or chronic cholecystitis between 1995 and 2005 were used in univariable and logistic regression analyses. Results: In total 31 838 patients, mean(s.d.) age 54.4(15.9) years, were analysed. The incidence of BDI was 0.3 per cent (101 patients), which did not change over time (P = 0.560). Univariable analysis revealed that male patients had a higher risk of BDI (0.5 per cent versus 0.2 per cent in female patients; P = 0.001), as did patients whose operation lasted at least 150 min (1.1 per cent versus 0.1 per cent for operating time of less than 150 min; P < 0.001). Logistic regression confirmed male sex (odds ratio (OR) 1.89, 95 per cent confidence interval 1.27 to 2.81) and prolonged surgery (OR 12.60, 10.87 to 23.81) as independent risk factors. Comparison of groups with and without intraoperative cholangiography showed no difference in the incidence of BDI (both 0.3 per cent; P = 0.755) and BDIs missed during surgery (10 versus 8 per cent; P = 0.737). Conclusion: Male sex and prolonged laparoscopic surgery are independent risk factors for BDI during LC. Frequent use of IOC does not seem to reduce BDI or the number of injuries missed during surgery.