General Surgeon Fails to Protect Bile Duct During Gallbladder Surgery

This case involves a fifty-six-year-old male patient who underwent a single incision laparoscopic cholecystectomy. The procedure was met with some complication as it was noted that the patient had an intrahepatic gallbladder with severe scarring at the triangle of Calot that proved to be a difficult dissection. Postoperatively, the patient was said to be recovering fine and was discharged soon after. The patient was readmitted to the hospital three weeks later for severe pain and jaundice and was noticed to have a large fluid collection that required drainage via ERCP along with a percutaneous left biliary drain placement. A cholangiogram was performed after the drainage which showed significant biliary damage that required referral for an extensive biliary reconstruction procedure.

Question(s) For Expert Witness

1. How often is the bile duct injured during this procedure and what are the most likely causes?

Expert Witness Response E-004465

The most dreaded complication of laparoscopic cholecystectomy is injury to the common bile or common hepatic duct. The estimated incidence of bile duct injury in cholecystectomies performed laparoscopically varies from 0.3-2.7%. In contrast, biliary tract injuries were noted to occur in 0.25-0.5% of open cholecystectomies. A major risk factor for bile duct injury is the experience of the surgeon and other risk factors are the presence of aberrant biliary tree anatomy and the presence of local acute or chronic inflammation.