Reconstruction of Bile Duct Injuries

Abstract

Bile duct injuries have become more common since the introduction of laparoscopic surgery, and they are a major source of morbidity and litigation. These injuries may take many forms, classified as Type A to Type E, (Fig. 77.1). In this classification of injuries to the biliary tract, Type E injuries are subdivided according to the Bismuth classification. Type B and C injuries almost always involve aberrant right hepatic ducts. The notations “> 2 cm” and “< 2 cm” for Type E1 and Type E2 indicate the length of common hepatic duct remaining. A Hepp-Couinaud approach can be used for injuries of Types E1, E2, and E3, but not for injuries with an isolated right duct – Types B, C, E4, and E5.

The simpler injuries, such as types A and D, may be treated at the index procedure when discovered intraoperatively, or by endoscopic or percutaneous techniques when they present in the postoperative period. Some injuries, such as E1 and E2 injuries, and occasionally more complex injuries, may be treated by nonsurgical techniques when they present as strictures. This chapter deals with injuries that require operative reconstruction – B and C injuries and most E injuries.