The Greek philosopher Diogenes (412 to 323 BC) founded the Cynic school of philosophy. Among his many ascetic practices, the one most popularly associated with him is the image of his endless search, lantern held aloft, for a man of truth. Why should this conjure up the image of a miniature counterpart of Diogenes, roaming the biliary tract, searching for the truth? Because the laparoscopic revolution has spawned a number of unresolved questions, not the least of which are centered on the biliary tract.
First, there is the question of bile duct injury. The current literature is replete with reports of large numbers of laparoscopic cholecystectomies without a single instance of common bile duct injury.1,2 Yet, reports continue to surface from major medical centers of an unusually high number of secondary referrals for repair of ductal injuries.3-5 What then is the true incidence of common bile duct injury?