Contemporary management of bile duct injuries

Laparoscopic cholecystectomy is the standard of care for symptomatic cholelithiasis, but it is associated with a higher incidence of bile duct injury (BDI) than the open approach. BDI can lead to mortality, significant morbidity and impaired quality of life. Immediate management of BDI recognized during cholecystectomy depends on the type of injury, the condition of the patient, and the experience of the surgeon. For patients presenting after cholecystectomy with a bile duct injury, the priority should be accurate assessment of the type of injury and early repair if possible; however for patients presenting after 2 weeks with established sepsis, it may be preferable to wait to allow appropriate control of sepsis and plan for definitive biliary reconstruction after 3 months. Proximal hepaticojejunostomy Roux-en-Y is the operation of choice in almost all situations, but other options may be possible in specific scenarios. The early reported association between an associated arterial injury and subsequent failure of biliary repair has not been confirmed by the largest studies. Excellent early and long-term results are possible when repair is undertaken in specialist units but long-term follow-up is required as late complications can occur.