Biliary Injury Repair

Biliary injury is one of the most dreaded complications of laparoscopic cholecystectomy and there are a lot of issues associated with its repair surgery such as the timing of repair, type of repair as well as an assessment of the vascular injury.

Here, we present a very interesting debate on the timing of repair of biliary injury. Immediate or an early repair can be undertaken provided that the conditions as explained in the talk are taken care of.
These points include resolution of sepsis, ruling out vascular injury, drainage of all collections, and the competence of the surgeon to perform the surgery.

In presence of vascular injury, the delayed repair is preferred and this has been explained in detail with the help of literary evidence as well as his own vast experience by Dr. Rajeev Joshi. This in combination with the evidence put forward for points favoring an early repair by Dr. Prasad Pande makes the debate very interesting and informative.

It is very useful to note that this debate comes to a common conclusion that the timing is not as important as the surgical planning as well as the competence of the team managing the patient. The common endpoint is achieving primary patency in the patient with the best possible approach whether in an immediate, early, or delayed setting.

The presence of vascular injuries is a contraindication to early repair. Other than that sepsis is again a contraindication to early repair. The debate highlights literature and current evidence with respect to both early and delayed repair and provides enough food for thought for both approaches.
This debate should clear the basics with regard to biliary injury management and provide you with the essential points to keep in mind while managing such patients.