Management of bile duct injuries

Abstract

Bile duct injuries (BDIs) take place in a wide spectrum of clinical settings. Injury to the extrahepatic biliary tract occurs most frequently due to damage occurred during upper abdominal operations, cholecystectomy being the principle scenario followed by other upper abdominal surgeries, and less commonly due to blunt or penetrating abdominal injury. The incidence of IBDIs has recently increased and associated with increased use of LC worldwide. IBDIs represent about 95% of all benign biliary strictures. Benign biliary strictures include wide spectrum involving not only IBDIs, but also biliary disorders caused by other pathogenic factors. IBDIs are complex health problem and although they usually occur in healthy young people, the effect on the patient’s quality of life and overall survival is substantial. Early and correct treatment allows prevention of serious complications in patients with IBDI. Unfortunately, late diagnoses, multiple attempts of repair and neglected care to avoid legal entanglements lead to extension and increase complexity of bile duct repair. The late clinical course of BDI leads to chronic liver disease, cirrhosis and portal hypertension, with the liver transplant being the last hope of cure. Therefore, more emphasis is placed on preventing these complications. Also, adequate training, several techniques were proposed to avoid BDI. Several factors are associated with increased risk of BDIs at the time of cholecystectomy. Some of these factors may be pathologic, anatomic variations, and or technical problems.Some of the factors are general while others are associated only with the laparoscopic approach itself. Ultimately, the final common pathway of most injuries is either a technical error or misinterpretation of the anatomy. It is essential to be careful in the proper visualization of the surgical area, identification of structures and anatomical variations, before ligation or transection to decrease the risk of BDIs during surgery. The final two strategies used to prevent IBDI are asking for experienced surgical eyes help and converting to open procedure.