Hepaticojejunostomy for iatrogenic bile duct injuries

Abstract

Iatrogenic bile duct injuries (BDIs) are a serious complication of cholecystectomy, with an incidence ranging from 0.1% to 0.25% in open procedures and 0.3% to 2.6% in laparoscopic ones. Hepaticojejunostomy (HJ) is considered the gold standard for managing these injuries. This case series presents four patients with iatrogenic BDI, all managed with HJ at a low-volume center. The injuries occurred during laparoscopic or open cholecystectomy, and all were identified intraoperatively. The types of injuries varied, including complete transactions and cautery-related damage to the common bile duct, with one case requiring re-exploration and a side-to-side Roux-en-Y HJ due to postoperative obstructive jaundice. In all cases, the surgical team demonstrated the ability to manage these complex injuries effectively, despite limited experience in advanced hepatobiliary procedures. The cases emphasize the importance of early identification and intraoperative management of BDI, even in low-volume centers. Postoperative recovery was uneventful in most cases, with patients being discharged within 5 to 6 days. This series highlights that with proper surgical expertise, iatrogenic bile duct injuries can be successfully managed with HJ. However, patient safety should remain the top priority. If there is any doubt, referral to a higher center with specialized hepatobiliary expertise is advised.