Risk factors for bile duct injury during laparoscopic cholecystectomy:
(1) problems in surgeon training and/or lack of experience
(2) carelessness on the part of the surgeon
(3) aberrant anatomy (of the right hepatic duct, short cystic duct, common bile duct)
(4) local risk factors (see below)
(5) equipment failure
(6) equipment misuse
(7) failure to perform intraoperative cholangiography or inadequate views
Local risk factors:
(1) chronic inflammation with dense scarring
(2) bleeding during the procedure that obscures the operative field
(3) fat in the operative field
(4) severe acute inflammation with friable structures (pancreatitis, cholangitis, empyema)
(5) portal hypertension
