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Injuries to the bile duct are almost universally iatrogenic and occasionally are due to trauma. The most common procedure leading to bile duct injury is the laparoscopic cholecystectomy. Prior to the advent of laparoscopic cholecystectomy, open cholecystectomy was used and was associated with a 0.1 to 0.2 percent risk of bile duct injury. With the introduction of laparoscopic cholecystectomy, the incidence has increased to 0.4 to 0.6 percent. This activity illustrates the evaluation and management of bile duct injuries and the types of repair available and highlights the role of the interprofessional team in managing patients who undergo bile duct repair. Objectives: Describe the anatomy of the biliary tree. Review the types of bile duct repair procedures available. Explain the classification of bile duct injuries. Summarize the importance of collaboration and communication amongst the interprofessional team to improve outcomes for patients undergoing bile duct repair. Access free multiple choice questions on this topic.

Injuries to the bile duct are almost universally iatrogenic and may infrequently be due to trauma.[1] The most common procedure causing a bile duct injury is laparoscopic cholecystectomy. Historically the incidence of bile duct injury while performing an open cholecystectomy was as low as 0.1% to 0.2%, but with the introduction of laparoscopic cholecystectomy, the incidence has increased to 0.4% to 0.6% of patients.[2] Laparoscopic cholecystectomy performed for acute cholecystitis and more so for gall bladder empyema or gangrenous cholecystitis, has a higher chance of bile duct injury.[3][4] Any major bile duct injury may result in significant morbidity, increased mortality, and financial burden on the patient.[5] These injuries should be prevented with meticulous technique and selective use of intraoperative cholangiography. The most common technique to repair major bile duct injuries is the Roux-en-Y hepaticojejunostomy (RYHJ).

Perioperative mortality is reported to be 1.7%, and morbidity is 43%.[5] The most common early complications are bile leak (5%), intraabdominal abscess (3%), wound infections (8%), and cholangitis (6%). Very few of these patients require intervention and if they do, it is by percutaneous means.[13] Late complications are primarily comprised of anastomotic stricture formation and recurrent cholangitis which with advancing techniques is highly responsive to endoscopic ballooning and stenting.[14]

Iatrogenic biliary tract injury is a rare but devastating complication of the commonly performed laparoscopic cholecystectomy in the modern age. The extent of the injury can range from mild to severe, and treatments vary according to the injury. Management of bile duct injuries has 3 main goals: control of sepsis, defining and classifying biliary anatomy/injury, and definitive repair of the injury. The bile duct injury is primarily managed by an interprofessional team that includes a surgeon, radiologist, gastroenterologist, infection disease consultant, and an intensivist. These patients usually require close monitoring in an ICU setting by critical care nurses and pharmacists for appropriate pain control and management of nutrition. Repair of bile duct injury is also associated with significant complications that include an anastomotic leak, abdominal abscess, liver failure, wound infections, and cholangitis. The mortality rates depend on the type of injury and comorbidity but can range as high as 20-40%. [Level 5][15][16][17]