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Objective: Major bile duct injury (BDI) after laparoscopic cholecystectomy (LC) remains a serious concern. This study was done to determine the national incidence and mortality for major BDI requiring operative reconstruction after LC in the United States during the years 2001-2009. Our results were compared to previously publish major BDI rates after LC reported between 1991 and 2000.
Design: Using the Nationwide Inpatient Sample of more than 4 million patients who underwent cholecystectomy for the years 2001-2009, we used procedure-specific codes to measure national estimates for LC. We then calculated biliary reconstruction procedures that occurred after LC. Biliary reconstruction performed as part of another primary procedure was excluded. Finally, we analyzed incidence and mortality rates associated with biliary reconstruction.
Results: The percentage of cholecystectomies performed laparoscopically has increased over time from 71% in 2001 to 78% in 2009. The associated mortality rate for LC was 0.56% in 2001 and 0.42% in 2009 (p = 0.002). The incidence of BDI requiring reconstruction after LC was 0.11% compared to 0.15% during 1991-2000 (p < 0.001). The average mortality rate for patients undergoing biliary reconstruction was 4.3% vs. 4.5% (p = 0.576) as reported previously.
Conclusions: The incidence of major BDI requiring reconstruction after LC has decreased slightly compared to that seen between 1991 and 2000. In addition, associated mortality rates are similar. This suggests that BDI requiring reconstruction after LC has attained a consistently low rate between 2001 and 2009.