The prevention of major bile duct injures in laparoscopic cholecystectomy: the experience with 13,000 patients in a single center.

Major bile duct injury (MBDI) is one of the most serious complications associated with laparoscopic cholecystectomy (LC). This study reports our experience in preventing MBDI during LC. Between September 1991 and August 2004, 13,000 cases of LC were performed at Kunming General Hospital. Systemic strategies, including selection of proper patients for LC based on the surgeons' experience, dissection techniques in Calot's triangle, selective use of laparoscopic ultrasonography, and indication of conversion to an open approach were developed and introduced to avoid MBDI. In our series, the overall incidence of MBDI was 0.085%, 0.60% (3 of 500) over the first period from September 1991 to September 1992, 0.17% (5 of 3000) over the second period from October 1992 to September 1996, and 0.03% (3 of 9500) over the third period from October 1996 to August 2004. The MBDI included transection of the common bile duct (CBD) due to mistaking CBD for cystic duct (n=6), cautery injury (n=3), laceration of the CBD at the junction of cystic duct and CBD (n=1), and clip partially of common hepatic duct due to blind hemostasis (n=1). The incidence of MBDI in our institution is acceptable. We believe the system strategies are effective to avoid MBDI in LC. LC is a safe procedure with an incidence of biliary injury comparable with that for open cholecystectomy.