This document discusses bile duct injuries (BDI) that can occur during cholecystectomy. It notes that BDI are rare but potentially devastating, and are most commonly caused by laparoscopic cholecystectomy. The document covers anatomy of the bile ducts, classifications of BDI, risk factors, prevention techniques like obtaining the "critical view of safety", and management approaches depending on the type and timing of injury identification. For injuries identified during surgery, the goal is usually repair or reconstruction. For later injuries, management involves drainage, antibiotics, and definitive reconstruction once inflammation decreases. Surgical repair via Roux-en-Y hepaticojejunostomy is often needed but endoscopic or radiologic techniques can sometimes be
6. Misperception ..
With sufficient cephalad retraction of the gall bladder
fundus ,the cystic duct overlies the common hepatic duct
running in a parallel path without inferolateral traction of
the gall bladder infundibulum to dossociate this
structures, the dissection of apparent cystic duct may
actually include CBD…
23. Identified After Cholecystectomy
GoalsofTherapyin Iatrogenic bile DuctInjury
1. Controlofinfectionlimiting inflammation
•Parenteralantibiotics Percutaneousdrainage
2. Clear andthorough delineation of entire biliary
anatomy.
MRCP/PTC,ERCP
3.Re-establishmentofbiliaryenteric continuity
•Tension-free,mucosa-to-mucosaanastomosisRoux-en-Yhepaticojejunostomy
•Long– termtransanastomoticstentsif involvingbifurcationorhigher
24. Approach..
Should undergo imaging to assess for a fluid collection and
evaluatethebiliary tree.
• Ultrasonography canachieveboththese goals.
• Cross-sectional imaging via CT will generally provide more
usefuldata.
• Radionucleotide scanning to confirm bile leakage, but
with anydocumentationof aleak, CTwill benecessaryto
planmanagement.
29. Tw o large retrospective reviews have been performed and
both have shown higher success rates from surgical
therapy, with lower morbidity and lower mortality
following operative management compared with those for
nonoperative strategies