Search for a command to run...
Abstract Iatrogenic bile duct injury (IBDI) remains a devastating complication of cholecystectomy, characterized by high morbidity, long-term disability, and significant medicolegal consequences. This study investigates the incidence, prevention strategies, and optimal management of these injuries, focusing on the "Critical View of Safety" (CVS) as the gold standard for intraoperative identification. Through a systematic review and meta-analysis of data spanning 1995 to 2026, including global trends and specific regional data from India and Kyrgyzstan, this research evaluates the efficacy of different diagnostic and therapeutic interventions. The methodology involved a comprehensive analysis of databases, surgical guidelines from SAGES, IAGES, and the Tokyo Guidelines, as well as multi-center prospective studies. Results indicate that visual misperception accounts for approximately 97% of injuries, with major ductal injuries occurring in 0.3% to 0.7% of laparoscopic cases. While minor leaks are effectively managed via endoscopic stenting, major transections require surgical reconstruction, primarily Roux-en-Y hepaticojejunostomy. A critical finding is the superiority of delayed repair (greater than six weeks) at specialized centers, which significantly reduces the risk of stricture and reoperation compared to intermediate-period interventions. Furthermore, emerging technologies such as Artificial Intelligence and Near-Infrared Fluorescence Cholangiography provide real-time decision support that enhances anatomical identification. The study concludes that the "biliary catastrophe" can be mitigated through a universal culture of safety, standardized anatomical landmarks, and prompt referral to hepatopancreatobiliary expertise. Keywords: Bile Duct Injury, Laparoscopic Cholecystectomy, Critical View of Safety, Hepaticojejunostomy, Surgical Safety, Hepatopancreatobiliary Surgery. I — Introduction The management of gallstone disease has been revolutionized by the transition from open to laparoscopic cholecystectomy (LC), which is now the undisputed gold standard for symptomatic cholelithiasis. However, this advancement has been accompanied by a persistent and life-altering surgical complication: iatrogenic bile duct injury (IBDI). Often termed the "biliary catastrophe," these injuries are not merely technical errors but represent a failure of anatomical identification that can lead to biliary cirrhosis, hepatic failure, and death.1 Background of the Medical Problem Cholecystectomy is among the most frequently performed abdominal surgeries worldwide, necessitated by a high global prevalence of gallstone disease. While open cholecystectomy was associated with a relatively low injury rate of 0.1% to 0.2%, the introduction of laparoscopy in the early 1990s saw these rates surge to between 0.3% and 1.3%.1 Although the surgical community initially attributed this increase to the "learning curve" associated with new minimally invasive technology, the incidence has reached a plateau, remaining higher than in the open era despite decades of experience.7 The fundamental issue in most major injuries is the misidentification of ductal structures, where the common bile duct (CBD) or common hepatic duct (CHD) is erroneously identified as the cystic duct and subsequently clipped and divided.1 These injuries are frequently more complex in the laparoscopic era due to the extensive use of electrosurgery and the limitations of two-dimensional visual depth.1 The consequences for the patient are profound, involving prolonged hospitalizations, multiple re-interventions, and a permanent reduction in health-related quality of life.11