Fundamentals of Bile Duct Injuries

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.

Juan Pekolj MD PhD, Chairman of General Surgery Service and of Liver Transplant Unit, is a staff HPB and liver transplant surgeon since 1989 at the Hospital Italiano de Buenos Aires, a Hepato-Pancreato-Biliary  surgery reference unit in South America.

For more than 30 years he has been assisting patients, promoting research and teaching about the management of bile duct injuries. He has been the director of many international courses, invited speaker at international meetings and he has written over 30 indexed papers and book chapters on this topic.

He has built a multidisciplinary team for the management of patients with bile duct injuries that has worked together for almost 20 years.

 Victoria Ardiles, MD, PhD is an Hepato-Pancreato-Biliary (HPB)  and liver transplant surgeon who works at the Hospital Italiano de Buenos Aires since 2001. Currently she is an associated staff of the General Surgical Service (leading the ambulatory laparoscopic cholecystectomy program) and the general coordinator of the Surgical Department. She is an active clinical researcher and teacher of research methodology. She also has a master degree in clinical research and other in health management.

Dr. Ardiles has written numerous papers and book chapters related to hepatobiliary pathology and surgical bile duct injuries. She has co-edited the Springer book Extreme Hepatic Surgery and Other Strategies: Increasing Resectability in Colorectal Liver Metastases.

 Juan Glinka, MD,  completed  a specialization in Hepato-Pancreato-Biliary (HPB) surgery at the Hospital Italiano de Buenos Aires, Argentina, and subsequently an American Society of Transplant Surgeons (ASTS) accredited fellowship in Abdominal Transplantation and HPB Surgery at Western University, Canada, where he now serves as an Assistant Professor of Surgery.

Dr Glinka is an active clinician and researcher in the field and has a special focus on minimally invasive HPB surgery along with Multi-Organ Abdominal Transplantation.