Commentary: The Classification and Injury Patterns of Iatrogenic Bile Duct Injury During Laparoscopic Cholecystectomy

Abstract

A bile duct injury (BDI) is one of the most dramatic complications during cholecystectomy. The incidence increased twofold after the introduction of the laparoscopic procedure (0.2–0.6 %) compared with open cholecystectomy (0.1–0.2 %). It has been shown that the incidence might be higher (0.7 %) for the single port laparoscopic procedure. The socioeconomic impact of BDI has been shown in many studies. There is also a relation with increased rates of malpractice litigation. BDI during cholecystectomy remains an area of extensive discussion in the literature including different opinions on incidence, prevention, and classification. There is a wide variety treatment options with ongoing controversy. The (long term) outcome of treatment of BDI is reported with different endpoints ranging from complications or mortality after surgery to normal liver function tests during follow up or no strictures/reoperations, and quality of life. The diversity in outcome in studies on patients suffering from a BDI is partly due to the fact that there is a wide variety on the definition of BDI. Another factor is the selection of patients with BDI in a study; for example: a cohort study at a primary institute or a selected group of patients from a referral center or a survey about BDI. Subsequently different classification systems have been used. Classification should be the first principal step in the management of patients suffering from a BDI. The wide variety in classification systems is one of the most important problems for comparison of studies on BDI. In the Chapter on the Classification and Injury patterns of BDI by E. K. Bartlett and Ch. M. Vollmer the 14 existing classification systems and differences between these systems have extensively been described. This is an elegant overview of different components in patients with a BDI which can be included in a classification system, as well as highlighting some of the shortcomings within these systems.