• Iatrogenic biliary injuries associated with laparoscopic cholecystectomy (most common), or other foregut operations.
  
• Operative approach depends on the time the injury is diagnosed (eg, immediately, early [≤ 4 weeks after injury], or late [> 4 weeks after injury]).
  
  
  
  • If the patient is hemodynamically stable, immediate biliary reconstruction is indicated when an injury is identified intraoperatively during a laparoscopic cholecystectomy or other operation and a hepatobiliary surgeon is available to perform the repair.
    
  • For patients with early or late injuries, operative management typically requires delayed biliary reconstruction with a biliary-enteric anastomosis.
  
  
• The aim of operative intervention is definitive treatment of patients with iatrogenic common bile duct or more proximal biliary injuries after the residual inflammation from the acute injury has resolved.
  
• If the injury has been thoroughly evaluated and the biliary system has been sufficiently decompressed and drained for 6 weeks or more, reconstruction is required if a biliary stricture persists or if biliary-enteric discontinuity remains.

Biliary Decompression

• Few contraindications exist for biliary decompression. This may be achieved using a percutaneous transhepatic approach or endoscopic retrograde-guided stent placement. Rarely, operative decompression may be required.

Percutaneous Transhepatic Approach

Absolute

• Active coagulopathy.

Relative

• Hepatic malignancy.
  
• Hydatid disease.
  
• Ascites.
  
• Contrast-related anaphylaxis.

Endoscopic Retrograde Approach