A 55-year-old woman undergoes laparoscopic cholecystectomy for gallstones. Intraoperative cholangiogram reveals a clip inadvertently placed across the common bile duct with complete transection. She is haemodynamically stable. The surgeon is proficient but has no hepatobiliary specialist immediately available. What is the BEST immediate action?
- A Attempt immediate primary repair over a T-tube
- B Remove the clip and place a biliary stent via fluoroscopy
- C Place drains, close the abdomen, and transfer to a specialist hepatobiliary centre ✓
- D Convert to open and perform immediate Roux-en-Y hepaticojejunostomy
Explanation
Bile duct injuries (BDI) at cholecystectomy should NOT be primarily repaired by the operating surgeon unless they have specialist hepatobiliary expertise. Immediate primary repair by an inexperienced surgeon carries high rates of anastomotic stricture and long-term morbidity. The recommended approach is to secure haemostasis, place abdominal drains, close the abdomen safely, and transfer the patient to a hepatobiliary unit. Roux-en-Y hepaticojejunostomy by a specialist is the gold standard reconstruction for complete transection injuries but must be performed by an experienced surgeon in optimal conditions.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.