Fundamentals of Bile Duct Injuries: From Prevention to Multidisciplinary Management

Bile duct injuries (BDI) are considered the most serious surgical  complication associated with cholecystectomy. According to different  reports, its incidence has remained constant over the years, ranging  from 0.1% to 0.9%. BDI is associated with a greater risk of  perioperative morbidity and mortality, a reduction in the quality of  life, and a decrease in long-term survival. Also, this complication is a  concern to surgeons since its progression is uncertain and may lead to  demands on professional responsibility ("malpractice") and emotional and  physical consequences ("second victim").

Given that injuries in a  high percentage of patients are initially unsuspected, the  postoperative recovery may be prolonged, and the possibility of a  successful repair reduced. Several surgical, endoscopic, and  percutaneous procedures may be necessary to manage the lesions and to  treat coexisting complications. BDI patients often undergo several  repair attempts before successful resolution. This affects their quality  of life and has a high psychological, physical, and mental impact due  to the prolonged, complex, and unexpected nature of the injury. This  currently represents a frequent problem in specialized referral centers  or hepatobilopancreatic surgery units, where patients arrive with the  sequelae of previous inadequate treatments. Usually, these patients  require more elaborate procedures such as reoperations, liver resections  and liver transplantation.

The prevention, early diagnosis, and  adequate treatment in the first approach is of crucial importance to  ensure good long-term results. Therefore, this book is an essential  resource for surgeons who perform cholecystectomy or treat BDI patients.  It provides practical information and a comprehensive review on  prevention and proper management, including complex cases. Readers will  find contributions by experienced authors from a multidisciplinary and  reference team in the management of BDI patients.