[Treatment of major iatrogenic lesions of the bile ducts]

The appropriate treatment of major bile duct injuries is mandatory in order to avoid serious complications, such as bile peritonitis or secondary biliary liver cirrhosis. In the last fourty years, surgical, endoscopic or radiologic techniques of cure have been proposed, but in our opinions, the preferred option is given by Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Creating an anastomosis on narrow bile duct could be difficult; in these really rare cases, the jejunal loop could be secured by a second suture to the hilar plate with satisfactory long-term results.

In the last four years, in our Institution, six patients underwent surgery for major bile duct injuries. A Roux-en-Y hepaticochojejunostomy was performed for all of them. Two patients had the jejunal loop secured to the hilar plate.

Operative morality was nil, and long-term results at a mean follow-up of 20 months are encouraging.

The prevention of major bile duct injuries remains the main target during cholecystectomy or surgery in the area of the hepatoduodenal ligament. In our experience, in general agreement with data from literature, bile reconstruction is best achieved by Roux-en-Y hepaticojejanostomy. In patients unsuitable for surgery, endoscopic balloon dilatation and stent positioning represent a satisfactory alternative.