Bile duct injury during cholecystectomy: causes, prevention and surgical repair in 1979

Bile duct injury during cholecystectomy is almost always a high injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restricturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux-en-Y, using transhepatic intubation and a "mucosal graft" type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting in six recurrent strictures needing a second reconstruction. At the end of 1978, 10 patients are too early to evaluate, two are dead and 20 have obtained a good final result.