Post-cholecystectomy Bile Duct Injury in Mexico: Prevention, Diagnosis, Management, and Healthcare System Challenges

Post-cholecystectomy bile duct injury (BDI) is an uncommon but potentially life-altering complication associated with repeated interventions, impaired quality of life, and substantial long-term morbidity. Although specialized Mexican centers have reported favorable outcomes in complex cases, the national burden, referral patterns, and access to hepatopancreatobiliary expertise remain poorly characterized. This structured narrative review synthesized evidence on the prevention, diagnosis, and management of BDI, with emphasis on the Mexican healthcare system. PubMed/MEDLINE, Embase, Scopus, and Google Scholar were searched for studies published from January 1990 to May 2026. Of 190 records identified, 19 primary studies met the eligibility criteria and were narratively synthesized. BDI appears to result from the interaction of distorted anatomy, visual misperception, unsafe continuation of dissection, technical and platform-related factors, and healthcare-system limitations. Prevention depends on reliable achievement of the Critical View of Safety and timely use of bailout strategies when anatomy cannot be safely defined. Intraoperative imaging may improve anatomical assessment but does not replace surgical judgment. Management should be individualized according to physiological stability, ductal continuity, injury level, contamination, and vascular involvement, with early source control and specialist hepatopancreatobiliary evaluation for major injuries. Mexican evidence is derived mainly from tertiary referral cohorts and suggests delayed recognition, prolonged referral, previous repair attempts, and unequal access to specialized care, despite favorable reconstructive outcomes at selected centers. Improving outcomes will require standardized referral pathways, avoidance of nonspecialist repair, regional centralization of complex reconstruction, and prospective multicenter surveillance.