Changing patterns of traumatic bile duct injuries: a review of forty years experience

Aim: To summarize the experiences of treating bile duct injuries in 40 years of clinical practice. Methods: Based on the experience of more than 40 years of clinical work, 122 cases including a series of 61 bile duct injuries of the Southwest Hospital, Chongqing, and 42 cases ( 1989-1997) and 19 cases (1998-2001) of the General Hospital of PLA, Beijing, cases were reviewed with special reference to the pattern of injury. A series of cases of the liver and the biliary tract injuries following interventional therapy for hepatic tumors, most often hemangioma of the liver, were collected. Chinese medical literature from 1995 to 1999 dealing with 2742 traumatic bile duct strictures were reviewed. Results: There was a changing pattern of the bile duct injury. Although most of the cases of bile duct injuries resulted from open cholecystectomy. Other types of trauma such as laparoscopic cholecystectomy (LC) and hepatic surgery were increased in recent years. Moreover, serious hepato-biliary injuries following HAE using sclerotic agents such as sodium morrhuate and absolute ethanol for the treatment of hepatic hemangiomas were encountered in recent years. Experiences in how to avoid bile duct injury and to treat traumatic biliary strictures were presented. Conclusion: Traumatic bile duct stricture is one of the serious complications of hepato-biliary surgery, its prevalence seemed to be increased in recent years. The pattern of bile duct injury was also changed and has become more complicated. Interventional therapy with sclerosing agents may cause serious hepatobiliary complications and should be avoided.