Mechanisms of Causation of Bile Duct Injury

Surgical video case: almost all bile duct injuries are iatrogenic; most occur during cholecystectomy. The visual perception error of misidentifying the common bile duct as the cystic duct is responsible for most bile duct injuries during laparoscopic cholecystectomy. A large number of bile duct injuries occur during what is thought by the surgeon to be a simple and uneventful cholecystectomy. Variations and aberrations of biliary anatomy (which are very frequent), difficult pathology (caused by complications of gall stone disease), and injudicious use of energy devices are also responsible for the causation of a bile duct injury during cholecystectomy. Men, obese patients, and some ethnic groups, e.g., Asians and Native American Indians, are more prone to bile duct injury during laparoscopic cholecystectomy. Desperate blind attempts to control bleeding in the Calot’s triangle may also cause a bile duct injury. Inexperience and overconfidence of the surgeon and not following the techniques of safe cholecystectomy are other factors.