Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):469-476. 10.14701/ahbps.2020.24.4.469.

Bile duct injury during laparoscopic cholecystectomy: An Indian e-survey

Affiliations
  • 1Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India

Abstract

Backgrounds/Aims
In the absence of national registry of laparoscopic cholecystectomy (LC) or its complications, it is impossible to determine incidence of bile duct injury (BDI) in India. We conducted an e-survey among practicing surgeons to determine prevalence and management patterns of BDI in India. Our hypothesis was that majority of surgeons would have experienced a BDI during LC despite large experience and that most surgeons who have a BDI tend to manage it themselves.
Methods
An 18-question e-survey of practicing laparoscopic surgeons in India was done.
Results
278/727 (38%) surgeons responded. 240/278 (86%) respondents admitted to a BDI during LC and 179/230 (78%) affirmed to more than one BDI. A total of 728 BDIs were reported. 36/230 (15%) respondents experienced their first BDI even after >10 years of practice and 40% had their first BDI even after having performed >100 LCs. 161/201 (80%) of the respondents decided to manage the BDI themselves, including 56/99 (57%) non-biliary surgeons and 44/82 (54%) surgeons working in non-biliary center. 37/201 (18%) respondents admitted to having a mortality arising out of a BDI; the mortality rate of BDI was 37/728 (5%) in this survey. Only 13/201 (6%) respondents have experienced a medico-legal case related to a BDI during LC.
Conclusions
Prevalence of BDI is high in India and occurs despite adequate experience and volume. Even inexperienced non-biliary surgeons working in non-biliary centers attempt to repair the BDI themselves. BDI is associated with significant mortality but litigation rates are fortunately low in India.

Keyword

Laparoscopic cholecystectomy; Bile duct injury; E-survey; Prevalence; Bile leak

Figure

  • Fig. 1 Bar chart to show the demography of surgical practice of respondents.

  • Fig. 2 Bar chart to show number of bile duct injuries experienced by the respondents.

  • Fig. 3 Bar chart to show number of laparoscopic cholecystectomies conducted prior to the first bile duct injury. RYHJ, Roux-en-Y hepaticojejunostomy.

  • Fig. 4 Bar chart to show time of detection of the first bile duct injury.

  • Fig. 5 Bar chart to type of management strategy used by the respondents. RYHJ, Roux- en-Y hepaticojejunostomy.


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