Bile duct injuries on a rise in the laparoscopic era?
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Laparoscopic surgery has helped significantly in many ways.If judisciously used it can reduce morbidity to a great extent. But this requires adequate training and expertise. Laparoscopic learning has to follow a certain cycle. This comprises of having done adequate number of open cases followed by practising on an endotrainer and then assisting a competant laparoscopic surgeon. Only after this cycle is completed is one capable of handling cases independently.
Due lack of a proper surgical curriculum being executed, surgeons who pass out are inadequately trained.As a result disastrous complications are to be seen these days.
The actual bile duct injury incidence has gone up significantly beyond what it used to be with open surgery. But these disasters are purposefully unreported. Once the bile duct is injured it is a misery for the patient.The safest way out for both the patient and the surgeon is to convert to open if there is slightest doubt of an anticipated technical difficulty.