Major iatrogenic bile duct injury during elective cholecystectomy: a Czech population register-based study

• Published in: Langenbeck's archives of surgery 2023-04, Vol.408 (1), p.154-154, Article 154
• Main Authors: Klos, Dušan, Gregořík, Michal, Pavlík, Tomáš, Loveček, Martin, Tesaříková, Jana, Skalický, Pavel
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - surgery; Abdominal Surgery; Bile Ducts - injuries; Bile Ducts - surgery; Cardiac Surgery; Cholecystectomy - adverse effects; Cholecystectomy, Laparoscopic - adverse effects; Czech Republic - epidemiology; General Surgery; Humans; Iatrogenic Disease - epidemiology; Medicine; Medicine & Public Health; Registries; Thoracic Surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2451; 1435-2443; 1435-2451
• DOI: 10.1007/s00423-023-02897-2

Purpose Bile duct injury (BDI) remains the most serious complication following cholecystectomy. However, the actual incidence of BDI in the Czech Republic remains unknown. Hence, we aimed to identify the incidence of major BDI requiring operative reconstruction after elective cholecystectomy in our region despite the prevailing modern 4 K Ultra HD laparoscopy and Critical View of Safety (CVS) standards implemented in daily surgical practice among the Czech population. Methods In the absence of a specific registry for BDI, we analysed data from The Czech National Patient Register of Reimbursed Healthcare Services, where all procedures are mandatorily recorded. We investigated 76,345 patients who were enrolled for at least a year and underwent elective cholecystectomy during the period from 2018–2021. In this cohort, we examined the incidence of major BDI following the reconstruction of the biliary tract and other complications. Results A total of 76,345 elective cholecystectomies were performed during the study period, and 186 major BDIs were registered (0.24%). Most elective cholecystectomies were performed laparoscopically (84.7%), with the remaining open (15.3%). The incidence of BDI was higher in the open surgery group (150 BDI/11700 cases/1.28%) than in laparoscopic cholecystectomy (36 BDI/64645 cases/0.06%). Furthermore, the total hospital stays with BDI after reconstruction was 13.6 days. However, the majority of laparoscopic elective cholecystectomies (57,914, 89.6%) were safe and standard procedures with no complications. Conclusion Our study corroborates the findings of previous nationwide studies. Therefore, though laparoscopic cholecystectomy is reliable, the risks of BDI cannot be eliminated.