To explore the strategy and efficacy of surgical treatments for iatrogenic bile duct injury (IBDI).

Clinical data of 34 IBDI patients admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2010 to December 2019 were retrospectively analyzed. Among them, 20 patients were male and 14 female, aged (53±15) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 6 patients, initially admitted to our hospital, were diagnosed with laparoscopic cholecystectomy-induced injuries. 28 cases were transferred to our hospital from other hospitals including 18 cases of laparoscopic cholecystectomy-induced injuries, 5 cases of open cholecystectomy-induced injuries, 4 cases of laparoscopic choledocholithotomy-induced injuries and 1 case of open choledocholithotomy-induced injury. The strategy and efficacy of surgical treatments were evaluated.

The bile duct injuries mainly occurred in the extrahepatic common bile duct area, especially in the hilar area and the upper segment of common bile duct. Immediate repair was delivered in 18 cases, early repair in 6 cases and delayed repair in 10 cases. 6 IBDI patients in our hospital immediately underwent end-to-end anastomosis of common bile duct, including 2 cases with T-tube retention. 28 patients transferred from other hospitals underwent repeated operations as follows: choledochojejunostomy in 13 cases, common bile duct repair with tissue flaps in 9 cases (4 cases with stomach flaps, 3 cases with gallbladder flaps, 2 cases with jejunal flaps), end-to-end anastomosis of common bile duct and T-tube drainage in 5 cases, and right hemihepatectomy in 1 case, respectively. The incidence of perioperative complications was 18%(6/34). No perioperative death occurred. The follow-up time was 2 to 114 months with a median of 46 months. During the follow-up, excellent efficacy was observed in 23 cases and good in 8 cases, with an excellent and good rate of 91%(31/34).

Early diagnosis and reasonable surgical treatments during operation play a key role in the treatment of IBDI. Biliary tract repair with Oddi sphincter function-preserved is the optimal treatment which yields definite long-term efficacy.