Editorial
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 7, 2009; 15(33): 4097-4104
Published online Sep 7, 2009. doi: 10.3748/wjg.15.4097
Iatrogenic bile duct injuries: Etiology, diagnosis and management
Beata Jabłońska, Paweł Lampe
Beata Jabłońska, Paweł Lampe, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, Medyków 14 St, 40-752 Katowice, Poland
Author contributions: Jabłońska B wrote this paper; Lampe P revised this paper.
Correspondence to: Beata Jabłońska, MD, PhD, Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, Medyków 14 St, 40-752 Katowice, Poland. bjablonska@poczta.onet.pl
Telephone: +48-32-2023434 Fax: +48-32-2023434
Received: June 25, 2009
Revised: July 21, 2009
Accepted: July 28, 2009
Published online: September 7, 2009
Abstract

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end-to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Keywords: Iatrogenic disease; Biliary drainage; Bile ducts; Cholecystectomy; Roux-en-Y anastomosis; Surgical injuries; Surgical anastomosis