Bile Duct Injury

Among the most challenging patients for surgeons are those with bile duct injuries (BDIs). BDI is associated with substantial morbidity, impaired quality of life, and mortality [1–4]. Morbidity following BDI is reported to be as high as 47 % and mortality anywhere from 1.7 to 9 % [1, 5, 6]. Morbidity and mortality is related not only to the severity of the BDI and associated bowel injury, but also to delays in management, inadequate management, or complications directly related to failed repair. Failed repairs can result in postoperative peritonitis, biliary sepsis, anastomotic stricture that can result in long-term recurrent cholangitis, biliary cirrhosis, and death. Numerous studies have noted that the level of BDI correlates with surgical outcome, with worse outcomes occurring more frequently in patients with higher levels of BDI [7–9].