Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 14, Issue 5, pp 476–479 | Cite as

Bile duct injury repair: when? what? who?

  • Vinay K. Kapoor
Review article

Abstract

Laparoscopic cholecystectomy is associated with a two-to-four times higher risk of bile duct injury (BDI) than open cholecystectomy. BDI can lead to significant morbidity and even mortality. The first priority in BDI is to control peritoneal and biliary sepsis and to convert an acute BDI to a controlled external biliary fistula (EBF) — this can be achieved by endoscopic and/ or radiological intervention in most cases. This should be followed by assessment of the extent of injury — both biliary and vascular. 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 BDI recognized after cholecystectomy, early repair is not recommended, as the results are poor. The EBF may evolve into a benign biliary stricture (BBS), which should be electively repaired by a Roux-en-Y hepatico-jejunostomy. The use of an endoscopic stent as definitive management of BDI is not recommended. Long-term follow-up is essential after the repair of a BBS, as recurrence can occur several years after repair. Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers.

Key words

Cholecystectomy Biliary fistula Bile duct injury Biliary stricture Hepatico-jejunostomy 

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Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Vinay K. Kapoor
    • 1
  1. 1.Department of Surgical GastroenterologySanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS)LucknowIndia

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