Iatrogenic bile duct injuries: diagnostic and therapeutic update from a safe surgical approach
Keywords:
Iatrogenic injuries; bile duct; cholecystectomy; laparoscopic surgery; hepaticojejunostomy; surgical preventionAbstract
Introduction:
Iatrogenic bile duct injuries (IBDI) represent one of the most feared complications of cholecystectomy, particularly when performed laparoscopically. Their clinical impact includes high morbidity, risk of sepsis, late strictures, and deterioration of quality of life.
Objective:
To update the diagnostic, therapeutic, and preventive aspects of IBDI, highlighting surgical principles that favor a safe and effective resolution.
Method:
A narrative literature review was conducted using the PubMed, SciELO, LILACS, and Google Scholar databases, prioritizing original articles, systematic reviews, and clinical guidelines published between 2020 and 2024. A total of 30 relevant references were selected based on recency, open access availability, and thematic relevance.
Development:
This section describes risk factors, the Strasberg classification, clinical manifestations, diagnostic methods (including intraoperative cholangiography and MR cholangiopancreatography), and therapeutic strategies according to the type of injury. Endoscopic, percutaneous, and surgical options are addressed, with emphasis on hepaticojejunostomy for complex injuries. Preventive principles such as the critical view of safety and subtotal cholecystectomy in difficult scenarios are also reviewed.
Conclusions:
Successful management of IBDI depends on early diagnosis, accurate classification, and individualized treatment by experienced teams. Prevention through standardized surgical techniques remains the most effective strategy to reduce their incidence.
Keywords:
Iatrogenic injuries; bile duct; cholecystectomy; laparoscopic surgery; hepaticojejunostomy; surgical prevention.
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References
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