Bile duct reconstructions are done after injuries to the bile duct. Bile duct injuries can result from blunt or penetrating external trauma from inadvertent injury during surgical operations, most commonly cholecystectomy, an operation to remove the gallbladder. A bile duct injury may be associated with injuries to the hepatic artery or portal vein, the major blood vessels carrying blood to the liver.
The less complicated injuries may be managed by insertion of a stent into the bile duct, either endoscopically from within the duodenum or by puncture through the abdominal wall and liver. More complicated injuries require anastomosis of an isolated segment of the upper small bowel (Roux loop) to the bile duct at its emergence from the liver. Sometimes, if there are associated vascular injuries, it may be necessary to combine this with the removal of part of the liver.
In cases where the injury is diagnosed immediately, reconstruction can be done, but if the diagnosis has been delayed and infection has become established, it may be safer to insert drains into the peritoneal cavity and bile ducts and treat with antibiotics for a variable period before doing a delayed reconstruction.
Most bile duct injuries are successfully repaired if done by an experienced and skilful hepatobiliary surgeon. However, many studies have shown that if the reconstruction is attempted by a surgeon who is not a specialist hepatobiliary surgeon, there is a high risk of anastomotic stricture, leak or other complications. In complicated cases, where the patient requires more than one surgery, recovery may take several months, and secondary biliary cirrhosis can develop and might necessitate a liver transplant. Complicated cases will also need careful nutritional replenishment, with particular reference to replacement of fat-soluble vitamins (A, D, E & K).