Risk factors for XXXX in laparoscopic cholecystectomy: analysis of 49 cases.

@entity1 @entity1157 @entity2679 @entity130
Forty-nine bile duct injuries, representing 0.8 per cent of 6076 laparoscopic cholecystectomies performed in the Netherlands in 1990-1992, were reviewed. The aim of the study was to classify the injuries according to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity of the injury. On the basis of operative findings, bile duct injuries were classified from minor (classes I-IIIa) to extensive with loss of bile duct tissue (IIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa, 18 in class IIIb and four in class IV. In 16 @entity1 the injury was detected during laparoscopic cholecystectomy and the procedure converted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of these 16 @entity1 . In 20 of the 33 @entity1 in whom identification of the injury was delayed to a second or third operation, more severe types of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P = 0.002). Of eight @entity1 with histologically proven acute @entity2679 at cholecystectomy, seven suffered @entity130 (class IIIb or IV). Surgical experience with laparoscopic cholecystectomy was an important factor in the incidence of @entity1157 .
