Bile duct injuries. Spectrum, mechanisms of injury, and their prevention.

Bile duct injuries remain a relatively uncommon but potentially devastating complication of both open procedures and laparoscopic procedures. They may present immediately after a given operation or take years to be recognized. Despite the best intentions of the surgeon, many of these injuries are imminently preventable. Recent advances in laparoscopic procedures have served to remind us of lessons learned from the prelaparoscopic era with respect to injuries of the bile ducts. To conduct any operation safely on or near the biliary system, the surgeon should be familiar with the anatomy and its variations, the nature of the pathologic processes that may enhance the likelihood of causing harm, and, most important, his or her own limitations and the limitations of the system with which he or she has to work.