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Surgical Innovation
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Risk Factors for Bile Duct Injury During Laparoscopic Cholecystectomy: A Case-Control Study

Ramin Kholdebarin, BSc

Division of Clinical Decision Making and Health Care, Toronto General Hospital

Jonathan Boetto, MSc

Division of Clinical Decision Making and Health Care, Toronto General Hospital

Julie L. Harnish, MA

Division of Clinical Decision Making and Health Care, Toronto General Hospital

David R. Urbach, MD

Division of Clinical Decision Making and Health Care, Toronto General Hospital, david.urbach{at}uhn.on.ca, Department of Surgery and Department of Health Policy, Management and Evaluation, University of Toronto Toronto, Ontario, Canada

Common bile duct injury is a serious but uncommon complication of laparoscopic cholecystectomy. A case-control epidemiologic study of patients who had undergone cholecystectomy in Ontario, Canada, between 1991 and 1997 was performed. Four patients who had undergone a laparoscopic cholecystectomy at the same hospital 2 months prior to a case were selected as controls. The risk of bile duct injury associated with various exposures was estimated by unconditional logistic regression. There were 28 cases and 88 controls. Emergency operation (adjusted odds ratio = 5.0; 95% confidence interval, 1.4-17.8) and failure to identify the cystic duct (adjusted odds ratio = 13.7; 95% confidence interval, 2.5-76.3) were statistically significant risk factors for operative bile duct injury. No other characteristics were independent risk factors for bile duct injury. Failure to identify the cystic duct and the emergency surgery are independent risk factors for bile duct injury.

Key Words: laparoscopic cholecystectomy • bile duct injury • case-control studies • risk factors

This version was published on June 1, 2008

Surgical Innovation, Vol. 15, No. 2, 114-119 (2008)
DOI: 10.1177/1553350608318144
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