Common Bile Duct Injury During Laparoscopic Cholecystectomy and the Use of Intraoperative Cholangiography

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Abstract
THE WIDESPREAD acceptance of laparoscopy as the preferred approach to cholecystectomy was based on anticipated reductions in postoperative pain and recuperative time associated with "minimal access."1 Soon after its introduction, however, it became clear that laparoscopic cholecystectomy (LC) was associated with unique complications compared with the "open" approach. Early reported rates of common bile duct (CBD) injury were 2 to 15 times2,3 greater than those identified in historic series. The incidence of CBD injury appeared to be highest during the introduction of LC and was related to early experience with LC, the so-called learning curve.1 As the procedure has become increasingly common, surgeons have tended to cite a rate of injury of 1:300. However, despite the broad experience of surgeons with LC during the past decade, rates of injury as high as 1.4%4,5 have recently been reported.