How Do Common Bile Duct Injuries Occur?
Common bile duct injuries occur most frequently during performance of a laparoscopic cholecystectomy. The injury typically occurs when the surgeon misidentifys the common bile duct for the cystic duct during the dissection phase of the operation.
The injury occurs in less than one percent of cholecystectomies. Excessive tension on the hartman’s pouch of the gallbladder by the surgeon’s first assistant may be contribute to this injury. Other factors, such as severe inflammation, the presence of visceral fat, bleeding from the dissection, or the mirizzi syndrome can make the dissection of the cystic duct treacherous to dissect off of the common bile duct.
Surgeons who perform laparoscopic cholecystectomy by exposing the “critical view” using a 360 degree dissection of calot’s triangle may have a lower incidence of biliary injuries.
What Happens After a Bile Duct Injury Occurs?
Injuries that are recognized at the time of the initial surgical procedure should be reconstructed immediately by an experienced surgeon performing a Roux-N-Y-Hepaticojejunostomy. Transfer of the patient to a specialized center for reconstruction by an expert is the preferred approach.
Unfortunately, many injuries are recognized at a remote time when patients recover poorly from surgery, often showing signs of bile peritonitis and intraabdominal sepsis. Reconstruction in this group of patients is performed in a delayed manner once the bile peritonitis and sepsis has been treated and resolves.
Common bile duct injuries are a source of significant morbidity for patients who have suffered from this complication.
Hear from the Expert
Leading bile duct and pancreas surgeon in Baltimore, MD, Dr. Mark Fraiman discusses common bile duct injuries and their management in his video below.