Biliary reconstruction.

The success of the initial repair after bile duct injury is critical to the long-term patency and function of the biliary tract. Dissection of the hilar plate, obtaining adequate width of the hepatic duct opening, and accurate mucosa-to-mucosa anastomosis are essential to achieving satisfactory reconstruction of the biliary tract. The plan of treatment for bile duct injuries should be tailored to the individual patient based on the type, level, and extent of the injury, the timing of diagnosis, the overall status of the patient, and the available expertise. The goal of therapy is not necessarily to avoid surgery but to achieve the best long-term results in the most cost-effective manner and with the least morbidity and mortality. A coordinated multidisciplinary approach to the diagnosis and treatment of patients with biliary injuries is now the standard.