Laparoscopic bile duct injury: Some myths

Laparoscopic cholecystectomy is now the standard treatment for symptomatic gall-bladder stones in most centres. Injury to the bile ducts is the most significant complication of laparoscopic cholecystectomy and is a major unsolved Surgical problem, feared because it is followed by Substantial morbidity, occasional mortality, large additional health-care costs and frequent litigation. Some regularly repeated statements, for which the evidence is inconclusive, appear in the literature and in medicolegal reports about this problem.(1) The present article critically examines four of these assertions that, in the absence of firm supporting evidence, can be termed 'surgical myths'. The views expressed in this paper are based on cases reviewed by the author as Chairman of the Australian Cases Committee of The Medical Defence Union, experience with 32 referred cases of bile duct injury and a review of the literature on laparoscopic cholecystectomy for the period 1990-2000.