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Invited Critique: Operative Repair of Bile Duct Injuries Involving the Hepatic Duct Confluence
O. Joe Hines, MD;
Howard A. Reber, MD
Los Angeles, Calif
Arch Surg. 1999;134:775.
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Jarnagin has previously made enormous contributions to our current thinking about the clinical management of a variety of hepatobiliary diseases, and he and his colleague have now presented some useful guidelines for the management of proximal bile duct injuries. They correctly stress the enormity of the morbidity associated with these injuries, their great economic impact (including the propensity for litigation), and the fact that the initial effort at repair provides the best chance for success.
As the authors suggest, the early management of these patients should focus on accurate delineation of the injury, control of infection (cholangitis and/or abscess), and drainage of the bile. Biliary drainage may be external via a surgically placed drain, or through a transhepatic tube inserted by the radiologist when a transhepatic cholangiogram is done. If the obstruction is incomplete, it may even be possible to pass the . . . [Full Text of this Article]
RELATED ARTICLE
Operative Repair of Bile Duct Injuries Involving the Hepatic Duct Confluence
William R. Jarnagin and Leslie H. Blumgart
Arch Surg. 1999;134(7):769-775.
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