Laparoscopic cholecystectomy has become the procedure of choice for the management of symptomatic gallstones. Which of the following statement(s) is/are true concerning laparoscopic cholecystectomy?

a. Injury to biliary tree occurs more frequently with laparoscopic cholecystectomy than open cholecystectomy

c. Bile duct injuries are more likely to occur during the surgeon’s early operative experience with the procedure

Laparoscopic cholecystectomy was first reported in 1988 and in recent years has supplanted open cholecystectomy as the treatment of choice in the management of calculous biliary tract disease. As experience with the technology increases, recommendations regarding contraindications for laparoscopic cholecystectomy have evolved. Absolute contraindications include the inability to perform laparoscopic cholecystectomy because of inadequate training or equipment, poor candidate for general anesthesia, uncontrolled coagulopathy, peritonitis, or suspected gallbladder carcinoma. Factors previously considered relative contraindications have been identified but with appropriate skill and judgment do not preclude the laparoscopic technique. These include acute cholecystitis, morbid obesity, previous upper abdominal surgery, cirrhosis, portal hypertension, and pregnancy. Laparoscopic cholecystectomy for acute cholecystitis is clearly more difficult and while the conversion rate of elective laparoscopic cholecystectomy to an open procedure is less than 5% in the setting of acute cholecystitis, the rate is approximately 20–30%. The incidence of bile duct injury in large surveys in this country and abroad suggest that the incidence of bile duct injury with open cholecystectomy is less than 0.2%. Initially much higher, (approaching 1%), several series of laparoscopic cholecystectomy have documented that injuries to the bile ducts currently occur at the rate of 0.2–0.6% of cases. There is a definite learning curve associated with performing laparoscopic cholecystectomy with most bile duct injuries likely to occur during a surgeon’s early operative experience with this procedure.