Repair of common bile duct injuries
- Keith D Lillemoe, MD, FACS
Keith D Lillemoe, MD, FACS
- W Gerald Austen Professor of Surgery
- Harvard Medical School
Common bile duct injuries represent a serious and challenging surgical complication. These complex injuries are most often a consequence of laparoscopic cholecystectomy (LC) . Proper management requires a skilled and experienced hepatobiliary surgical team.
This topic will focus on the surgical repair of common bile duct injuries. Details of LC techniques and endoscopic management of complications from LC are discussed elsewhere.
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- MECHANISM OF INJURY
- Role of intraoperative cholangiography
- CLASSIFICATION OF BILIARY INJURIES
- RECOGNITION OF BILE DUCT INJURY
- Intraoperative diagnosis
- When to postpone bile duct repair
- Delayed presentation
- - Bile leak
- - Biliary obstruction
- GOAL OF OPERATIVE MANAGEMENT
- REPAIR OPTIONS
- Segmental or accessory duct injury
- Transection of common bile duct
- - Short injured segment or distal injury
- - Long injured segment or proximal injury
- - Type E1 (Bismuth I)
- - Type E2 and E3 (Bismuth II and III)
- - Type E4 (Bismuth IV)
- - Type E5 (Bismuth V)
- Operative technique
- Morbidity and mortality
- Quality of life
- SUMMARY AND RECOMMENDATIONS