Role of Intraoperative Cholangiography in Avoiding Bile Duct Injury

Abstract

Each year, over 750,000 patients undergo cholecystectomy in the United States, making it the most frequently performed abdominal surgical procedure. ¹ Flum D.R. Dellinger E.P. Cheadle A. et al. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003; 289 : 1639-1644 Crossref PubMed Scopus (335) Google Scholar Common bile duct (CBD) injury during cholecystectomy occurs with relative infrequency (∼ 1 in 200 to 400) ¹ Flum D.R. Dellinger E.P. Cheadle A. et al. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003; 289 : 1639-1644 Crossref PubMed Scopus (335) Google Scholar ^{,  2} Flum D.R. Koepsell T. Heagerty P. et al. Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error?. Arch Surg. 2001; 136 : 1287-1292 Crossref PubMed Scopus (136) Google Scholar but ranks among the leading sources of medical malpractice claims against surgeons. ³ laparoscopic injury study and risk management review for general surgery. Vol 6. Physician Insurers Association of America, Rockville, MD 2000: 11 Google Scholar Between 34% and 49% of surgeons are expected to cause such an injury during their career. ⁴ Archer S.B. Brown D.W. Smith C.D. et al. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001; 234 ( discussion 558–559) : 549-558 Crossref PubMed Scopus (270) Google Scholar ^{,  5} Francoeur J.R. Wiseman K. Buczkowski A.K. et al. Surgeons’ anonymous response after bile duct injury during cholecystectomy. Am J Surg. 2003; 185 : 468-475 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar Repair of such injuries is often complex and requires multiple procedures. ⁴ Archer S.B. Brown D.W. Smith C.D. et al. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001; 234 ( discussion 558–559) : 549-558 Crossref PubMed Scopus (270) Google Scholar ^{,  6} Kern K.A. Malpractice litigation involving laparoscopic cholecystectomy Cost, cause, and consequences. Arch Surg. 1997; 132 ( discussion 397–398) : 392-397 Crossref PubMed Scopus (99) Google Scholar ^{,  7} Lillemoe K.D. Martin S.A. Cameron J.L. et al. Major bile duct injuries during laparoscopic cholecystectomy Follow-up after combined surgical and radiologic management. Ann Surg. 1997; 225 ( discussion 468–471) : 459-468 Crossref PubMed Scopus (165) Google Scholar Major CBD injury also has a substantial impact on quality of life, functional status, ⁸ Boerma D. Rauws E.A. Keulemans Y.C. et al. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg. 2001; 234 : 750-757 Crossref PubMed Scopus (174) Google Scholar ^{,  9} Melton G.B. Lillemoe K.D. Cameron J.L. et al. Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg. 2002; 235 : 888-895 Crossref PubMed Scopus (164) Google Scholar ^{,  10} Moore...