Related issues in repair of bile duct injury and traumatic biliary stricture

Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis,formation of hepatolithiasis,and biliary cirrhosis.This article elaborates on the influencing factors for the effect of the repair of bile duct injury and traumatic biliary stricture,repair principles,timing of repair or reconstruction,and related methods and techniques.It is pointed out that if there is no significant local infection and the bile duct wall defect is < 2 cm,end- to- end anastomosis should be used for repair;if the bile duct wall defect is > 2 cm,Roux- en- Y hepaticojejunostomy should be used for reconstruction.If the upper wall of the bile duct had a large defect and the lower wall has an integral structure,pedicled umbilical vein graft,pedicled jejunal wall seromuscular flap,or gastric wall seromuscular flap should be used for repair.The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction.Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy.The key to successful repair is exposure and removal of high hilar bile duct stricture,while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts,and therefore,it is a good method for exposing high bile duct stricture.