The rate and complexity of bile duct injuries was evaluated in 83,449 patients who underwent laparoscopic cholecystectomy between 1995 and 2008 in the Kaiser Permanente Northern California system. Fifty-six surgeons who performed a laparoscopic cholecystectomy in the past were surveyed to determine factors that predispose to bile duct injuries.
The overall incidence of bile duct injuries was .10 % ; 59.5 % of the 84 injuries were cystic duct leaks. Incidence varied slightly from .10 % (1995-1998) to .08 % (1999-2003) and .12 % (2004-2008). There was a trend toward more proximal injuries (injury <2 cm from the bifurcation: 14.3 % to 44.4 % to 50.0 % of major injuries). The misinterpretation of anatomy was cited by 92.9 % of surgeons as the primary cause of bile duct injuries; 70.9 % cited a lack of experience as a contributing factor.
Laparoscopic cholecystectomy has an overall low risk of bile duct injuries; the rate remains constant, but injury complexity may have increased over time.