Bile duct injuries during laparoscopic cholecystectomy with systematic implementation of critical view of safety and intraoperative cholangiography

Abstract

Background: Background: Critical view of safety and systematic intraoperative cholangiography are the most accepted strategies to prevent bile duct injury (BDI) during laparoscopic cholecystectomy.
Objective: The aim of this study was to describe the incidence, severity and management of these injuries during laparoscopic cholecystectomy that occurred despite the use of both strategies.
Material and methods: We conducted a retrospective, descriptive and observational study of planned laparoscopic cholecystectomies performed between July 2008 and July 2018. Demographic data, preoperative diagnoses and intraoperative findings were analyzed.
Results: During the period analyzed, 2447 planned laparoscopic cholecystectomies were performed. The critical view of safety was obtained in 2425 (99.1%) patients and 2437 (99.6%) patients underwent intraoperative cholangiography. Five patients (0.2%) a preoperative diagnosis associated with difficult cholecystectomy, developed BDI, 4 of them involving aberrant right bile ducts. All the cases were diagnosed and managed during the original surgery.
Conclusion: Bile duct injuries, particularly those involving aberrant right bile ducts, can occur in patients with diagnoses associated with difficult cholecystectomies despite the use of the critical view of safety and intraoperative cholangiography.