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Review
. 2019 Mar 6:12:121-128.
doi: 10.2147/CEG.S169492. eCollection 2019.

Iatrogenic bile duct injury: impact and management challenges

Antonio Pesce  1 , Stefano Palmucci  1 , Gaetano La Greca  1 , Stefano Puleo  1
Affiliations
Review

Iatrogenic bile duct injury: impact and management challenges

Antonio Pesce et al. Clin Exp Gastroenterol. .

Abstract

Iatrogenic bile duct injuries (BDIs) after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patient's quality of life. The primary aim of this review was to discuss the classification of BDIs, the proposed methods to prevent biliary lesions, the associated risk factors, and the management challenges depending on the timing of recognition of the injury, its extension, the patient's clinical condition, and the availability of experienced hepatobiliary surgeons. Early recognition of BDI is of paramount importance and limiting the diagnosis delay is crucial for an optimal postoperative outcome. The therapeutic management depends on the type and gravity of the biliary lesion, and includes endoscopic, radiologic, and surgical approaches.

Keywords: bile duct injury; biliary anatomy; early recognition; endoscopic treatment; laparoscopic cholecystectomy; management challenge; surgical repair.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Stewart-Way classification of bile duct injuries. Notes: Adapted with permission from Wolters Kluwer Health, Inc.: Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460–469. Copyright © 2003 Lippincott Williams & Wilkins, Inc. Available from: https://journals.lww.com/annalsofsurgery/Abstract/2003/04000/Causes_and_Prevention_of_Laparoscopic_Bile_Duct.4.aspx. The Creative Commons license does not apply to this content. Use of the material in any format is prohibited without written permission from the publisher, Wolters Kluwer Health, Inc. Please contact permissions@lww.com for further information.
Figure 2
Figure 2
Intra-operative real-time identification of biliary structures with visible light (VL) on left and by fluorescence (NIRF-C) on right. Note: Cystic duct (CD) running parallel to the common hepatic duct (CHD). Abbreviation: NIRF-C, near-infrared fluorescent cholangiography.
Figure 3
Figure 3
(A) Axial three-dimensional MRCP sequence showing a small fluid collection in the gallbladder fossa (white arrow). (B) T1-weighted hepatobiliary acquisition (after gadoxetic acid injection) demonstrates opacification of the small fluid collection suggesting a biliary leak from the cystic duct. Abbreviation: MRCP, magnetic resonance cholangio-pancreatography.
Figure 4
Figure 4
Trans-Kehr cholangiography after the positioning of T-tube to protect biliary anastomotic suture. Notes: Normal cholangiogram showing opacification of the cystic duct, CBD, common hepatic duct, right and left hepatic ducts, and the duodenum. The biliary tree is free without strictures and there is no evidence of biliary leak. Abbreviation: CBD, common bile duct.
Figure 5
Figure 5
A hepaticojejunostomy was performed for a stricture at biliary confluence after the positioning of T-tube.
See this image and copyright information in PMC

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