Management of bile duct injuries: a practical approach.

The incidence of bile duct injury (BDI) has increased after the introduction of laparoscopic cholecystectomy. A BDI can occur in the hands of experienced surgeons also. It can result in serious complications and may even cause death of the patient; it also has financial and legal implications. Proper training, sound surgical technique, and conversion to an open operation can prevent a large number of injuries. An injury that is missed during the operation manifests in the postoperative period as a bile leak and external biliary fistula or during the follow up as a biliary stricture. Management of a BDI depends on the nature of the bile duct injured, type of injury, and expertise available; it may range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy. Excellent results can be obtained when BDI is managed at a hepatobiliary center.