Etiology of Bile Duct Injuries During Laparoscopic Cholecystectomy

Abstract Introduction: Laparoscopic cholecystectomy (LC) is a surgical procedure indicated for the treatment of medical conditions involving the removal of a diseased gallbladder. One of the most common and severe complication of laparoscopic cholecystectomy (LC) is bile duct injury (BDI). In such a widely performed procedure it is imperative to understand the etiology as well as any underlying risk factors that may lead to BDI. The Aim: To assess and analyse the various causes and trends in the incidence and risk factors of bile duct injuries during a period of 25 years . Materials and Methods: We performed a retrospective cohort study involving 120 patients who underwent LC over a period of 25 years from 1994 till 2024, divided into 2 groups to analyse the changing trends over the course of time. Socio-demographic and clinical data was collected, the most statistically significant parameters included gender, anatomic anomalies, number of laparoscopic cholecystectomies performed by the surgeon, intraoperative cholangiography as a method of diagnosis as well as cause of the operation. Results: We found that 38 patients developed bile duct injury in the period of first five years from 1999–2004 (31.6%) while 23 patients developed bile duct injury in the period of last five years from 2019–2024 (19.1%). Acute cholecystitis was found to be leading risk factor in (47.40%) cases in first group and 56.20% cases in the second group. 88% patients developing BDI were female. Experience of surgeon reporting bile duct injury varied from less than 25 procedures performed (1999–2004) to more than 100 procedures performed (2019–2024). Conclusion: Our study indicates that proper training and experience of surgeons is a key determinant in development of BDI. Acute cholecystitis was recognised as a high risk factor that leads to complications during LC. The routine use of intra-operative cholangiography are the best methods currently available for timely identifying and hopefully preventing bile duct injuries during laparoscopic cholecystectomy.