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Invited Critique
August 2010

Bile Leaks and Sepsis: Drain Now, Fix Later: Comment on “Bile Duct Injuries Associated With Laparoscopic Cholecystectomy”

Author Affiliations

Author Affiliations: Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa.

Arch Surg. 2010;145(8):763. doi:10.1001/archsurg.2010.154

This article highlights the unresolved and vexing question of the best time to repair a bile duct after a laparoscopic injury. There is consensus that the most favorable results are achieved when an experienced hepatobiliary team performs the repair. Several recent reports have suggested that in selected patients the results of early repair are as good as delayed repair with the intuitive advantages of shorter hospital stay and earlier resumption of normal activities. Once a BDI is identified, the principles of management are well defined. Effective drainage of intraabdominal sepsis, if present, and detailed cholangiographic evaluation of the biliary tree are critical as is reconstruction by a surgeon with expertise in biliary surgery.

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