腹腔镜胆囊切除术高位胆管损伤的预防及处理

目的探讨腹腔镜胆囊切除术中高位胆管损伤的原因、预防及处理方法。方法对2009年1月至2014年1月我科收治外院转入的16例腹腔镜胆囊切除术后胆管损伤的病例和同期我科腹腔镜胆囊切除术2200例无胆管损伤的临床资料进行分析。结果16例胆管损伤的部位均为肝总管横断及毁损伤,其中11例行肝总管-空肠Roux-en-Y吻合术,5例行左右肝管整形-空肠Roux-en-Y吻合术,16例病人术后恢复良好,无死亡病例。同期2200例LC术中采用“肝总管显露”确认后再行胆囊切除无一例发生胆管损伤。结论腹腔镜胆囊切除术高位胆管损伤最多见,术中“肝总管显露”是预防高位胆管损伤的可靠方法。肝总管（或左右肝管整形）-空肠Roux-en-Y吻合术是治疗高位胆管损伤最有效的手术方式。     

高位胆管损伤及其处理

目的 探讨高位胆管损伤的原因、类型和处理方法.方法 回顾性总结分析了1998-2005年间对38例胆管损伤的诊治过程,其中腹腔镜胆囊切除术（LC）术中损伤24例,开腹胆囊切除术（OC）术中胆管损伤14例;高位胆管损伤21例.结果 所有胆管损伤病人均行手术治疗,分别行胆管对端吻合、胆管修补、肝管空肠吻合及胆管空肠吻合术.结论 LC手术发生胆管损伤多为高位胆管损伤,以行肝胆管空肠吻合术作为主要治疗手段,胆管损伤经手术修复后仍有一定术后并发症发生率.     

医源性胆管损伤14例临床分析

收集鄂尔多斯市2006年1月—2021年5月5家医院发生的14例因腹腔镜胆囊切除术导致胆管损伤患者的临床资料,并对胆管损伤的病因、损伤类型、胆管修复手术时机及术式、预后进行回顾性分析。术中发现胆管损伤有8例,术后发现胆管损伤6例,所有患者均行修复性手术治疗,修复手术类型:胆管-空肠Roux-en-Y吻合术12例,胆管对端吻合术有1例,胆管间断修补术1例。初次修复手术中有10例治疗成功;4例在初次修复手术后出现并发症需要进一步治疗,其中3例再次接受手术治疗。远期预后优良率达78.6%。胆管损伤原因复杂多样,首次修复手术最为关键,尤其施术者经验及手术时机至关重要。胆管-空肠Roux-en-Y吻合术可能是治疗严重胆管损伤的安全有效的手术方法。     

49例腹腔镜胆囊切除术所致医源性胆管损伤的处理

目的探讨腹腔镜胆囊切除术所致胆管损伤的处理时机及疗效评价。方法回顾总结2001年1月至2011年12月期间我院收治的49例腹腔镜胆囊切除术所致医源性胆道损伤患者的临床资料,对损伤胆道的手术时机及其疗效进行分析。结果 49例患者中,29例行肝管空肠Roux-en-Y吻合术,19例行胆管空肠Roux-en-Y吻合术,1例行胆总管修补术。10例在腹腔镜胆囊切除术后3d内再次手术,27例在3 d～6周内再次手术,12例在6周后再次手术。15例患者出现不同的远期或早期并发症。统计学分析发现,在3 d～6周内再次手术的患者较容易出现胆道狭窄(P=0.03)。结论胆道损伤修复手术在胆道损伤后3d内或6月后施行可减少胆道狭窄的发生。     

胆囊切除致胆管损伤原因探讨及处理

目的探讨胆囊切除致胆管损伤的原因及处理措施。方法回顾性分析近7年收治27例胆囊切除致胆管损伤的临床资料。27例胆囊切除致胆管损伤病例中,实施手术34例次,其中胆肠Roux—en—Y吻合术为19例次。结果全组末次近期效果：优20例（74．1％）,良6例（22．2％）,死亡1例（3．7％）。随访2～7年（平均3年）20例,其中胆肠Roux—en-Y吻合术15例,优11例（73．3％）,良3例（20．0％）,差1例（6．7％）。结论胆囊切除术致胆管损伤,损伤的原因主要与其术式选择不当、手术时机把握不当及术者经验不足有关。胆管损伤时要取得好的疗效,关键是及时发现和正确处理。胆管空肠Roux-en—Y吻合术是大多数胆管损伤或损伤性胆管狭窄修复重建的有效术式。     

胆囊切除致肝外胆管损伤16例临床分析

目的 探讨胆囊切除致肝外胆管损伤修复的时机和方法。 方法 回顾性分析1985年1月至2009年12月中国医科大学附属第一医院普通外科16例胆囊切除致胆管损伤的确诊时间与修复时机。 结果 术中发现（确诊）4例,术后早期确诊10例,后期确诊2例。术中及术后确诊的12例胆管横断性损伤及2例腹腔镜胆囊切除术（LC）远期胆管瘢痕性狭窄行胆管空肠Roux-en-Y吻合术。2例时间较短（＜6个月）效果难以评估。12例无胆道感染及胆管炎等吻合口狭窄表现。1例LC术后5d黄疸行开腹手术发现2枚钛夹夹闭胆总管,拆除钛夹行胆总管T管引流术。1例小切口胆囊切除术（MC）术后胆漏,内镜下鼻胆管引流术（ENBD）4周后痊愈。结论 根据胆管损伤的确诊时间、损伤程度而采取不同的处理方法;如不适合行对端吻合及自身生物瓣修复时,胆管空肠Roux-en-Y吻合术是常用而有效的方法。     

胆囊切除相关性胆道损伤的诊治分析

目的探讨胆囊切除术导致的胆道损伤的原因及治疗方法方法回顾性分析我院近十年来开展开腹胆囊切除术573例(包括中转开腹胆囊切除术86例)和腹腔镜胆囊切除术4374例共出现9例胆管损伤的分型及处置方案。结果术中发现胆管损伤7例一期修复,并T管支撑引流,术后随访预后良好。疑似胆管损伤术后胆漏2例,放置双套管引流后胆漏自行闭合1例,延期胆肠吻合术1例,术后恢复可,无胆道狭窄发生。结论胆囊切除术相关性胆道损伤术中即刻发现即刻修复重建加上合适有效的支撑引流,能够获得较好的预后。     

腹腔镜胆囊切除术胆管损伤修复术预后因素的研究

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中胆道损伤的原因、类型、修复方式与预后的关系。方法：对1995年至2006年间因行LC导致胆管损伤6例患者的临床资料进行回顾性分析。结果：5例胆管损伤在术中及时发现并立即处理,其中4例治愈,1例术后1月T管脱落,发生胆管吻合口狭窄,经再次行胆肠Roux-en-Y吻合术治愈;1例胆管壁电热伤,术后发生腹腔、胆道出血,再次手术探查示胆管壁坏死,放置T管支架治愈。结论：LC胆管损伤处理应依据胆管损伤原因、类型,采取正确的处理方式,方可取得良好的远期效果。     

胆道损伤修复术后再狭窄的治疗：附22例报告

目的:探讨医原性胆道损伤修复术后再狭窄的治疗.方法:回顾分析2001年1月-2011年12月期间收治的胆道损伤经外院修复后再狭窄的22例临床资料.22例胆道损伤均由胆囊切除所造成,其中8例为腹腔镜胆囊切除术,14例为开腹胆囊切除术.结果:22例患者均再次手术,21例行胆管空肠Roux-en-Y吻合术(1例因胆管损伤位置较高,肝方叶切除后行左右肝管空肠吻合),1例行U管引流术.所有患者经1～11年随访,除l例因胆道感染继发肝功能衰竭死亡外,其他21例患者近远期疗效尚可.结论:胆管损伤发生后应及早修复,注重手术操作的细节,选择合理修复方法;胆管空肠Roux-en-Y吻合术是治疗修复术后再狭窄的可靠术式.     

胆囊切除术致胆管损伤28例外科治疗体会

目的 提高胆囊切除术致胆管损伤的外科治疗水平.方法 回顾性分析28例胆囊切除术致胆管损伤的临床资料.结果 术中发现的19例胆管损伤病例均行一期胆道重建术,包括胆管断端对端吻合术6例、肝外胆管空肠端侧Roux-Y吻合术7例和左肝管空肠侧侧Roux-Y吻合术6例.在胆管断端对端吻合术6例中,有2例术后出现胆道狭窄而行再次胆道重建术.术后发现的胆管损伤9例中,3例行一期胆道重建,包括左肝管空肠Roux-Y吻合术2例和肝总管空肠端侧Roux-Y吻合术1例;3例行二期胆道重建术,包括肝总管空肠端侧Roux-Y吻合术1例、左肝管空肠侧侧Roux-Y吻合术1例和胆管空肠黏膜移植术1例;1例行结扎松解后胆管切开加T形管支撑引流术;1例行胆管裂伤修补加胆总管T形管引流术;1例行保守治疗.术后疗效满意.结论 术中及时发现和术后早期诊断胆管损伤,针对不同损伤类型选择相应术式并注重胆道重建的质量可以提高胆管损伤的修复效果;不必常规放置经吻合口的支撑引流管;Smith空肠黏膜移植术可应用于某些高位胆管损伤的二期修复重建.     

Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients

Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%. AIM OF THE STUDY: Describe the management of biliary injuries after laparoscopic cholecystectomy in our center. PATIENTS: Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%). RESULTS: Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2). CONCLUSION: Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.     

Analysis of bile duct injuries (Stewart-Way classification) during laparoscopic cholecystectomy

In order to investigate mechanisms underlying the occurrence of bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC), we analyzed results for 34 patients (0.59%; 17 men, 17 women; average age, 57 years) with BDI out of 5750 LCs, based on questionnaire responses from surgical operators, records of direct interviews with these operators, operative reports, and videotapes of the operations. The indications for LC in the 34 patients were chronic cholecystitis in 32 patients and acute cholecystitis in 2. The BDIs in these patients were divided into four classes using the Stewart-Way classification: class I, incision (incomplete transection) of the common bile duct (CBD), n = 6 (17.6%); class II, lateral damage to the common hepatic duct (CHD), n = 9 (26.5%); class III, transection of the CBD or CHD, n = 15 (44.1%); and class IV, right hepatic duct or right segmental hepatic duct injuries, n = 4 (11.8%). In all class III and 3 class I cases (18 in total; incidence 53%), the mistake involved misidentifying the CBD as the cystic duct. Of all types (classes) of injuries, class III injuries showed the mildest gallbladder inflammation, and there was a significant (P = 0.0005) difference in the severity of inflammation between class II and III injuries. We conclude that complete transection of the CBD, which is rare in laparotomy, was the most common BDI pattern occurring during LC and that the underlying factor in the operator making this error was mistaking the CBD for the cystic duct.     

腹腔镜胆道修复重建术治疗腹腔镜胆囊切除术中的胆管损伤

目的腹腔镜手术出现胆管损伤后通常需要中转开放手术修复或二期手术,给患者增加极大的痛苦。能否采用腹腔镜手术的方法修复胆管损伤是一个值得探讨的问题。本研究的目的是探讨腹腔镜修复术治疗术中和术后早期发现的医源性胆管损伤的方法和可行性。方法总结分析2002年11月至2012年12月采用腹腔镜修复重建术治疗的11例术中或术后早期发现的医源性胆管损伤的资料。11例发生在腹腔镜胆囊切除术中（11／1485,0．74％）。男7例,女4例,平均年龄57．4岁（26～70岁）。其中6例为胆管轻度损伤,5例为高位胆管横断的重度胆管损伤。按刘允怡分类法,11例胆管损伤的损伤类型分别是：I型2例,ⅡA型2例,IIIA型2例,ⅣA型3例,ⅣB型2例。9例胆管损伤在术中发现,另2例在术后2d发现。针对不同的损伤类型采用不同的修复方法。2例肝总管部分轻度损伤（UA型）的患者采用镜下缝合修补、T管引流来修复g1例右肝管孔状损伤的患者采用镜下单纯缝合修复;1例胆总管误扎的患者在镜下松解结扎线、胆总管探查、T管引流;1例胆囊床迷走小胆管横断的患者镜下缝扎封闭;1例胆囊颈残余胆漏的患者采用镜下切除残余胆囊、缝扎胆囊管的方法修复;另外5例高位胆管横断伤（肝总管或者左、右肝管横断伤）的患者采用镜下损伤的胆管对端吻合、硅胶支架管内引流的方法修复。结果11例胆管损伤（BDI）患者均完全腹腔镜下一期修复术,无中转开腹手术。术后患者恢复顺利,无腹腔感染、无伤口感染等并发症发生。胆管修复术后平均住院时间是8．9d（5～15d）。患者均获得随访,随访时间8个月-10年不等。11例患者均无胆管狭窄。有1例患者发生过一次胆管炎,CT发现胆总管轻度扩张,行经内镜逆行性胰胆管造影术检查未发现胆总管结石,无胆管狭窄、肿瘤,考虑胆管轻度扩张为十二指肠乳头炎性狭窄引起,行经内镜下乳头括约肌切开术后治愈。其余10例患者无胆管炎、胆管狭窄等长期并发症。结论轻度胆管损伤可以采用镜下单纯缝合修补或T管引流治疗,胆管横断损伤可以采用腹腔镜下胆管对端吻合术、支架引流管内引流管术的治疗。腹腔镜下胆管修复术用于治疗医源性胆管损伤是有效可行的。然而,手术的难度极大,技术要求高,必须由具有丰富的胆道外科手术和娴熟的腹腔镜技术的专家进行手术。     

Liver Transplantation: The Last Measure in the Treatment of Bile Duct Injuries

BACKGROUND: Bile duct injury (BDI) is a severe complication that may arise during the surgical treatment of a benign disease. A significant proportion of cases develop end-stage liver disease and a liver transplant is required. The aim of this study was to analyze the indications and results of liver transplantation as treatment for BDI. METHODS: Between January 1988 and May 2007, 20 patients with end-stage liver disease secondary to BDI were included on the liver transplant waiting list. Retrospective charts were analyzed and survival was estimated by the Kaplan-Meier test. RESULTS: Four patients died while on the waiting list and 16 received a transplant. Injury to the bile duct occurred during a cholecystectomy in 13 of 16 patients, with the main cause of the lesion being duct division in six patients and resection in four. All patients had received some surgical treatment (median = 2 procedures) before being considered for a transplant. The liver transplant came from a cadaveric donor for all patients and the median time between BDI and liver transplant was 60 months. Two patients died in the postoperative period and nine had complications. Three patients died in the late postoperative period. Median follow-up was 62 (range = 24-152) months. One-, three-, and five-year survival rates were 81, 75, and 75%, respectively. CONCLUSION: Complex bile duct injuries and bile duct injuries with previous repair attempts can result in end-stage liver disease. In these cases, liver transplantation provides long-term survival.     

Bile duct injuries during laparoscopic cholecystectomy: a collective experience of four teaching hospitals and results of repair

BACKGROUND: Laparoscopic cholecystectomy has been performed in Singapore since 1990 and, up until the end of 1997, a total of 4445 procedures had been performed in the four major teaching hospitals. Although bile duct injuries were thought to have increased following the introduction of laparoscopic cholecystectomy, there have been no reviews done on the incidence of these injuries in the Singapore context. METHODS: The present retrospective review aimed to audit the rate of bile duct injuries in the four major teaching hospitals in Singapore and to document the results of management of these injuries. RESULTS: Of the 4445 procedures performed, there were 19 (0.43%) cases of bile duct injuries. These involved the common hepatic duct (n = 8), common bile duct (n = 10), and the right hepatic duct (n = 1). The underlying gall bladder pathology included non-inflamed gall bladders (n = 10), acute cholecystitis (n = 4), Mirrizzi's syndrome (n = 3) and mucocele of the gall bladder (n = 2). Transection of the duct accounted for the majority of the injuries. Eleven bile duct injuries were identified at the time of operation. These were primarily repaired over a T tube (n = 4) or by a bilio-enteric bypass (n = 7). The remainder were diagnosed at a median of 7 days (range: 1-556 days) after surgery with a presentation of jaundice or pain. These were repaired by bilio-enteric anastomosis (n = 7) and closure over a T tube (n = 1). Three patients developed strictures subsequently, two following bilio-enteric repair after delayed diagnosis and one following immediate primary repair over a T tube. One patient developed intrahepatic stones and required a left lateral segmentectomy. CONCLUSIONS: The experience of a 0.43% bile duct injury rate is comparable to the best results from most large series in the West. Inflammation at Calot's triangle is an important associated factor for injury. Early recognition and prompt repair affords good results, and hepaticojejunostomy is recommended as the repair of choice.     

术中胆道损伤143例的原因及处理

目的讨论术中胆道损伤的原因及处理方法。方法分析我院1970年1月至2003年12月治疗的术中胆道损伤143例,占同期胆道手术的2.83%。男59例(41.26%),女84例(58.74%),平均年龄为44.7岁。导致胆道损伤的手术类型为胆道手术129例(90.21%),胃切除5例(3.5%),其他手术9例(6.29%)。损伤类型以胆管横断和部分切除等为多,术中发现并当即处理者69例(48.25%),3d内二次手术者28例(19.58%),1个月内手术者13例(9.09%),半年以后再次手术者33例(23.08%)。结果死亡7例(4.90%)(死亡原因为肝功能衰竭及严重感染),治愈136例,治愈率为95.1%,随访1～30年,平均9.4年,随访期间胆道狭窄19例(13.29%),均经再次手术治愈。结论术中胆道损伤的发生率为0.1%～3%,以胆囊切除术多见。术者缺乏训练,暴露欠佳,照明差,局部粘连为主要原因。疑有损伤者应行术中胆道造影及胆总管探查,确认后当即行修补或胆肠吻合,置管支撑、引流。术中胆道损伤多需再次手术,死亡率明显增加。     

MRCP在预防LC手术并发症中的价值

目的评价磁共振胰胆管成像(MRCP)在预防腹腔镜胆囊切除(LC)手术并发症中的价值。方法回顾性分析2006年1月至2010年6月期间我院收治的1 079例拟行LC治疗的患者的临床资料。根据不同时期行MRCP与否分为非MRCP组(n=523)和MRCP组(n=556),对2组患者胆管损伤及胆总管结石残余情况进行比较。结果非MRCP组35例患者中转开腹,MRCP组41例患者中转开腹。非MRCP组患者术中及术后出现胆管损伤5例,胆总管结石残余27例;MRCP组患者术中未出现胆管损伤以及胆总管结石残余,2组患者在胆管损伤和胆总管结石残余方面比较的差异均有统计学意义(P=0.026和P=0.000)。对于非MRCP组患者,术中胆道造影55例,发现胆总管结石23例。MRCP组3例患者术前MRCP未发现而术中经过胆道造影发现胆总管结石,另3例患者术前MRCP提示而术中胆道造影未发现胆总管结石。MRCP组患者术前MRCP发现双胆囊1例,Mirizzi综合征8例,胆囊管变异34例,副肝管28例,胆总管结石27例,与术中结果相比,其诊断的准确性分别为100%、87.5%、94.1%、89.3%和88.9%。结论 LC患者术前行MRCP有利于预防胆管损伤及胆总管结石残余的发生。     

胆管损伤十二例分析

目的胆管损伤是腹腔镜胆囊切除术最为严重的并发症。最佳的胆道修复措施仍存在争议。本研究旨在评估在武汉市第一医院肝胆专科其术中胆管损伤的发生、修复处理及预后情况。方法单中心回顾性分析2012年1月至2015年12月胆道手术病例3 126例,对12例胆管损伤病例的人群分布、疾病原因、损伤类型、修复方式、中转率、术后并发症、预后结果、医疗纠纷等因素进行分析。结果在3 126例胆道手术中,胆管损伤的总体发生率为0.38%,而腹腔镜胆囊切除术中Strasberg A型以上的损伤率仅为0.17%;依照Strasberg分类,其中A型5例(41.7%),D型3例(25.0%),E1型1例(8.3%),E2型3例(25.0%),均未合并血管损伤。12例胆管损伤主要的疾病性原因为Mirizzi综合征(25.0%)、炎症水肿(25.0%)、迷走胆管(25.0%)和胆囊萎缩(16.7%)。腔镜下简单处理(凝闭、套扎、夹闭或缝闭)6例,中转开腹处理6例(50.0%),其中一期缝合1例、脐静脉修补1例、胆管端端吻合2例、Roux-en-Y肝管空肠吻合2例。术后并发症3例(25.0%),其中DindoClavien分级,2级1例(胆漏)、3a级1例(胆漏并后期狭窄),5级1例(死亡)。胆管损伤处理总体成功率为83.3%,医疗投诉纠纷率为16.7%。结论凭借专科经验的累积,胆管损伤的发生率是可以控制在较低水平的。正确地辨识高危因素、胆道修复医师的专业经验、合理的外科决策对于提高胆道修复的成功率、回避医疗纠纷至关重要。     

Prevention of bile duct injury: the case for incorporating educational theories of expertise

Background

Over 700,000 laparoscopic cholecystectomies are performed yearly in the US. Despite multiple advantages of laparoscopic surgery, the increased rate of bile duct injury (BDI) compared to the traditional, open approach to cholecystectomy remains problematic. Due to the seriousness of bile duct injury, the time has come for an aggressive educational campaign to better train laparoscopic surgeons in order to reduce the incidence of this life-threatening and expensive complication.

Methods

We performed a literature review of what is currently known about the causes of bile duct injury during laparoscopic cholecystectomy. Based on these reviews, we identified educational theories of expertise that may be relevant in understanding variable rates of BDI between surgeons. Finally, we applied educational theories of expertise to the problem of BDI in laparoscopic cholecystectomy to propose how to develop and design an effective educational approach for the prevention of BDI.

Results

Multiple studies demonstrate that the primary causes of BDI during laparoscopic cholecystectomy are non-technical. Additionally, there exists a learning curve in which the rates of BDI are higher in a surgeon’s earlier cases compared to later cases and that some surgeons perform laparoscopic cholecystectomy with significantly fewer injuries than others. Educational theories indicate that interventions that optimize novice to expert development require (1) revealing expert knowledge to novices and (2) scaffolding the mental habits of expert-like learners.

Conclusions

BDI is an appropriate target for the application of educational theories of expertise. Designing better educational interventions for the prevention of BDI will require uncovering the hidden knowledge of expert surgeons and incorporating the processes of reinvestment and progressive problem solving that are inherent to expert performance.     

Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons

BACKGROUND: Bile duct injury (BDI) after laparoscopic cholecystectomy (LC) has an enormous socioeconomic impact on patients. BDI has been associated with severe morbidity, impaired survival, and poor long-term quality of life. This study was performed to analyze the impact of a multidisciplinary approach in BDI patients on survival. METHODS: A prospective cohort study was performed in a tertiary referral center to determine the effect of a multidisciplinary treatment on survival in 500 bile duct injury patients. Referral pattern and patient survival after bile duct injury are analyzed, and a survey was performed on the prevalence of medical litigation in bile duct injury patients. RESULTS: The number of patients referred to the Amsterdam Medical Center increased to 0.3% of the total number of patients, yearly undergoing laparoscopic cholecystectomy in the Netherlands. The referral rate to the departments of gastroenterology (n = 329), surgery (n = 146), and radiology (n = 25) was, respectively, 66%, 29%, and 5%. After referral to the tertiary center, 150 patients (30%) were internally referred to a different department to optimize treatment. The 10-year survival rate in bile duct injury patients is not significantly worse compared with the age-matched general Dutch population (89% vs 88%, P = .7). Overall, 19% of the patients submitted a medical litigation claim against the initial surgeon or hospital. In total, 40% of these claims were resolved in the favor of the patients through settlement or verdict. CONCLUSIONS: BDI is a severe complication in modern surgical practice. BDI is associated with major morbidity and high rates of litigation claims. The detrimental effect of BDI on survival can be prevented if gastroenterologists, radiologists, and surgeons work together in a multidisciplinary team.