Prevalence and Risk Factors of Bile Duct Injury During Laparoscopic Cholecystectomy in Iraqi Hospitals
Downloads
The standard surgical procedure for treating symptomatic gallstone disease is laparoscopic cholecystectomy; however, complications such as injury to the bile duct could occur. This study examined the prevalence and the risk factors associated with bile duct injury resulting from laparoscopic cholecystectomy at Al-Hussein Teaching Hospital in Samawa, Iraq. A retrospective and prospective observational study was performed using a total of 2,840 patients who had undergone laparoscopic cholecystectomy during the five-year period of this study. Data were subsequently identified for the patient’s demographics, preoperative diagnosis, intraoperative findings, and experience level of the surgeon. The overall prevalence of bile duct injury was determined to be 0.74%. The multivariate logistic regression analysis identified that several independent risk factors are associated and include male gender, acute cholecystitis with severe inflammation, intraoperative bleeding, aberrant biliary anatomy, and procedures performed by junior surgeons. The majority of injuries were classified as type E2 based on the Strasberg classification. Overall, this study supports that while the prevalence of bile duct injury is slightly higher than worldwide data from other industrialized countries, the findings resemble those found, on average, in other developing countries. Adherence to the critical view of safety, early conversion to open surgery with hostile anatomy, and supervised training for junior surgeons would be needed to decrease the risk of developing injury to the bile duct during laparoscopic cholecystectomy.
[1] S. M. Strasberg, M. Hertl, and N. J. Soper, “An analysis of the problem of biliary injury during laparoscopic cholecystectomy,” J. Am. Coll. Surg., vol. 180, no. 1, pp. 101–125, 1995.
[2] D. R. Flum, T. Koepsell, P. Heagerty, M. Sinanan, and E. P. Dellinger, “Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: Adverse outcome or preventable error?” Arch. Surg., vol. 136, no. 11, pp. 1287–1292, 2001.
[3] G. Nuzzo, F. Giuliante, I. Giovannini, et al., “Bile duct injury during laparoscopic cholecystectomy: Results of an Italian national survey on 56,591 cholecystectomies,” Arch. Surg., vol. 140, no. 10, pp. 986–992, 2005.
[4] H. J. Asbun, R. L. Rossi, J. A. Lowell, and W. C. Barker, “Bile duct injury during laparoscopic cholecystectomy: Mechanism, prevention, and management,” Surg. Endosc., vol. 7, no. 6, pp. 420–424, 1993.
[5] B. Tornqvist, C. Stromberg, G. Persson, et al., “Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: Population based cohort study,” BMJ, vol. 345, p. e6457, 2012.
[6] A. Waage and M. Nilsson, “Iatrogenic bile duct injury: A population-based study of 152,776 cholecystectomies in the Swedish Inpatient Registry,” Arch. Surg., vol. 141, no. 12, pp. 1207–1213, 2006.
[7] S. Connor and O. J. Garden, “Bile duct injury in the era of laparoscopic cholecystectomy,” Br. J. Surg., vol. 93, no. 2, pp. 158–168, 2006.
[8] U. F. Giger, J. M. Michel, I. Opitz, D. T. Inderbitzin, T. Kocher, and L. Krähenbühl, “Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: Analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database,” J. Am. Coll. Surg., vol. 203, no. 5, pp. 723–728, 2006.
[9] S. Yegiyants and J. C. Collins, “Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy,” Am. Surg., vol. 74, no. 10, pp. 985–987, 2008.
[10] K. A. Booij, P. R. de Reuver, J. van Dillen, et al., “Factors increasing the risk for bile duct injury during laparoscopic cholecystectomy: A register-based case-control study,” Surg. Endosc., vol. 30, no. 9, pp. 3928–3936, 2016.
[11] A. M. Davidoff, T. N. Pappas, E. A. Murray, et al., “Mechanisms of major biliary injury during laparoscopic cholecystectomy,” Ann. Surg., vol. 215, no. 3, pp. 196–202, 1992.
[12] F. T. Korkmaz, N. N. Arslan, D. Dokmeci, et al., “Risk factors for bile duct injury during laparoscopic cholecystectomy: A multicenter analysis,” J. Laparoendosc. Adv. Surg. Tech. A, vol. 30, no. 4, pp. 401–406, 2020.
[13] N. J. Soper and D. L. Dunnegan, “Does intraoperative cholangiography prevent bile duct injury during laparoscopic cholecystectomy?” Surg. Endosc., vol. 8, no. 4, pp. 313–315, 1994.
[14] A. Suwal, B. Sigdel, A. Shrestha, et al., “Bile duct injury during laparoscopic cholecystectomy: A tertiary care center experience,” J. Nepal Med. Assoc., vol. 57, no. 218, pp. 425–429, 2019.
[15] S. B. Archer, D. W. Brown, C. D. Smith, G. D. Branum, and J. G. Hunter, “Bile duct injury during laparoscopic cholecystectomy: Results of a national survey,” Ann. Surg., vol. 234, no. 4, pp. 549–558, 2001.
[16] J. P. Dolan, B. S. Diggs, B. C. Sheppard, and J. G. Hunter, “Ten-year trend in the national volume of bile duct injuries requiring operative repair,” Surg. Endosc., vol. 19, no. 7, pp. 967–973, 2005.
[17] J. K. Sicklick, M. S. Camp, K. D. Lillemoe, et al., “Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: Perioperative results of a 200-patient prospective experience,” Ann. Surg., vol. 241, no. 5, pp. 786–792, 2005.
[18] T. B. Hugh, “New strategies to prevent laparoscopic bile duct injury—Surgeons can learn from pilots,” Surgery, vol. 132, no. 5, pp. 826–835, 2002.
[19] M. Frasson, C. Bortul, C. Orsini, et al., “Bile duct injury during laparoscopic cholecystectomy: A prospective cohort study,” World J. Surg., vol. 40, no. 9, pp. 2190–2198, 2016.
[20] W. Ji, L. T. Li, Z. M. Wang, Z. F. Quan, X. R. Chen, and J. S. Li, “Role of intraoperative cholangiography in avoiding bile duct injury: Meta-analysis of randomized controlled trials,” World J. Gastroenterol., vol. 11, no. 26, pp. 4087–4092, 2005.
Copyright (c) 2026 American Journal of Biomedicine and Pharmacy
This work is licensed under a Creative Commons Attribution 4.0 International License.
