To investigate the causes and prevention of bile duct injury in laparoscopic cholecystectomy (LC).

Clinical data of 1 157 patients undergoing LC in Huainan Xinhua Hospital in Anhui province from March 2011 to September 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 519 patients were male and 638 female, aged (48±6) years old on average. A total of 214 cases were diagnosed with acute cholecystitis and 943 cases of chronic cholecystitis. The incidence of intraoperative and postoperative bile duct injury and bile leakage were taken as the primary observation parameters. The incidence of bile duct injury and its risk factors were analyzed. The incidence of bile duct injury was statistically compared by Chi-square test.

The incidence of bile duct injury was 0.43% (5/1 157), including 2 cases of bile leakage caused by vagus bile duct injury, 1 case of right hepatic duct injury induced by excessive resection of gallbladder bed, 1 case of right hepatic duct injury caused by variation of cystic duct opening and 1 case of common bile duct injury caused by excessive stretching of cystic duct. The incidence of bile duct injury in patients undergoing elective LC was 0.4%(4/943) and 0.5%(1/214) for those undergoing emergency LC where no significant difference was observed (χ²=0.231, P>0.05). The incidence of bile duct injury in LC performed by the attending physicians was 1.1%(4/370), significantly higher than 0.1%(1/787) in LC performed by the deputy chief and above physicians (χ²=5.324, P<0.05). The incidence of LC bile duct injury in the surgeons with LC experience < 20 cases was 1.3%(3/229), and was 0.2%(1/525) for those with LC experience of 20-100 cases and 0.2%(1/403) for those >100 cases, where significant differences were observed (χ²=3.787, P<0.05).

Anatomical variation and tissue adhesion of bile duct are the common impact factors of bile duct injury. Experienced surgeons, good command of anatomical variation of bile duct before LC, careful blunt separation of Calot's triangle and delicate operations play a key role in preventing and reducing bile duct injury during LC.