Related Experiment Video
Updated: Apr 18, 2026
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Major liver resection as definitive treatment in post-cholecystectomy common bile duct injuries
Juan Pekolj1, Alejandro Yanzón, Agustin Dietrich
1HPB Surgery and Liver Transplant, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina, juan.pekolj@hospitalitaliano.org.ar.
Insights
Major hepatectomy is a successful treatment for complex common bile duct injuries (CBDI), even with vascular involvement. This approach offers excellent long-term survival, though it involves significant postoperative morbidity requiring expert care.
Area of Science:
- Hepatobiliary Surgery
- Surgical Complications
- Gastroenterology
Background:
- Common bile duct injuries (CBDI) are severe complications following cholecystectomies, frequently involving vascular structures, posing significant management challenges.
- Effective treatment strategies for complex CBDI, particularly those with vascular compromise, remain an area of critical clinical interest.
Purpose of the Study:
- To evaluate the outcomes of major hepatectomy in patients with severe common bile duct injuries (CBDI).
- To analyze the indications, postoperative complications, and long-term results of major hepatectomy for CBDI.
Main Methods:
- A retrospective review of 287 patients with CBDI treated between 1993 and 2013.
- Major hepatectomy was performed in 15 patients (5%) with severe CBDI (Strasberg E4/E5), including those with vascular involvement and failed prior treatments.
- The median delay between injury and hepatectomy was 24 months.
Main Results:
- Ten right and five left hepatectomies were performed. Postoperative morbidity was 60%, with serious complications (≥ grade IIIa) in 40%.
- No mortality was observed. The mean follow-up was 43.5 months, with 100% overall survival.
- Three patients experienced ascendant cholangitis, successfully managed medically. All other patients remained asymptomatic, with no further surgical interventions required.
Conclusions:
- Major hepatectomy is an effective treatment for complex common bile duct injuries (CBDI), yielding excellent long-term outcomes.
- Despite high postoperative morbidity, major hepatectomy provides a viable solution for selected CBDI cases.
- Management of these complex injuries necessitates a multidisciplinary approach within specialized Hepato-Pancreato-Biliary (HPB) surgery centers.
Background:
Common bile duct injuries (CBDI) are serious complications of cholecystectomies which are often associated with vascular involvement, meaning that their management represents a major challenge to the physician. We present our experience in major hepatectomy due to CBDI, highlighting indications, postoperative complications, and long-term outcomes.
Methods:
From August 1993 to September 2013, 287 patients with CBDI were treated in our centre. In 15 patients of this group (5 %), a major hepatectomy was performed. Eleven patients presented E4 and four presented E5 injuries of Strasberg classification. Seven patients presented vascular involvement. In 12 patients, prior treatment attempts, either biliodigestive anastomosis, endoscopic or percutaneous drainage, was performed without success. The median time delay between lesional surgery and hepatectomy was 24 months.
Results:
Right hepatectomy was performed in 10 patients and left hepatectomy in 5. Postoperative morbidity was 60 %. The incidence of serious complications (≥ grade IIIa of DC classification) was 40 %. There was no mortality in our study. The mean follow-up was 43.5 months and the overall survival was 100 %. Three patients had a single episode of ascendant cholangitis who were successfully treated with medical treatment. All other patients were asymptomatic during follow-up. No patients required further surgical procedures.
Conclusion:
In our series, major hepatectomy due to CBDI was a successful treatment with high rates of postoperative morbidity and excellent long-term outcomes which require a multidisciplinary approach in referral centres of HPB surgery.
More Related Videos
05:22Intraoperative Strategy under Complex Vascular Adhesion for Laparoscopic Radical Resection of Bismuth-Corlette Type IIIb Perihilar Cholangiocarcinoma
Published on: February 13, 2026
07:36Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023