SURGICAL APPROACHES TO THE MANAGEMENT OF HEPATIC VASCULOBILIARY INJURIES: A RETROSPECTIVE SINGLE-CENTER EXPERIENCE
DOI:
https://doi.org/10.11603/2414-4533.2026.1.15717Keywords:
laparoscopic cholecystectomy, biliary injury, liver resection, biliary reconstruction, vasculobiliary injuryAbstract
Objective. To determine the indications for hepatic resection in patients with iatrogenic biliary and vasculobiliary injuries, to assess the surgical risks and effectiveness of resectional procedures, and to analyze postoperative morbidity and mortality rates.
Materials and Methods. Between January 2004 and December 2024, 46 liver resections were performed for biliary and vasculobiliary injuries at the Department of Liver Transplantation and Surgery, Shalimov National Institute of Surgery and Transplantology, National Academy of Medical Sciences of Ukraine. The study included patients who underwent hepatic resection as a definitive treatment for iatrogenic biliary or vasculobiliary injury.
Results. According to the Strasberg classification, high-grade injuries predominated, with type E4 identified in more than half of the cases (54.4%). Less common were types E5 (23.9%), E3 (13%), and C (8.7%). A vascular component was present in 76% of patients: isolated right hepatic artery injury was recorded in 41% of cases, while combined injury to the right hepatic artery and right portal vein branch occurred in 20%. Major hepatic resections were the most frequently performed procedures: extended right hepatectomy in 41.3% of patients, right hepatectomy in 28.3%, and right trisectorectomy in 15.2%. Vascular reconstruction was required in 8.7% of cases. The postoperative mortality rate in the cohort was 15.2%.
Conclusion. Hepatic resection remains the only justified surgical approach for patients with iatrogenic vasculobiliary injuries, particularly in the presence of ischemic parenchymal necrosis or severe septic complications. The substantial postoperative morbidity and mortality observed in this patient population highlight the need for careful preoperative selection, as well as ensuring complete control of infectious foci and optimization of the patient’s general condition prior to surgery. Effective management of sepsis and chronic biliary inflammation is essential to reduce the risk of postoperative liver failure, anastomotic dehiscence, and treatment-related mortality.
Received: 15.12.2025 | Revised: 12.01.2026 | Accepted: 18.02.2026
References
Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003 Apr; 237(4):460-9. DOI: 10.1097/01.SLA.0000060680.92690.E9. PMID: 12677139; PMCID: PMC1514483.
Angelou A, Damaskos C, Garmpis N, et al. An analysis of the iatrogenic biliary injury after robotic cholecystectomy. Current data and future considerations. Eur Rev Med Pharmacol Sci. 2018 Sep; 22(18):6072-76. DOI: 10.26355/eurrev_201809_15945. PMID: 30280793.
Flum DR, Cheadle A, Prela C et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003 Oct. 22; 290(16):2168-73. DOI: 10.1001/jama.290.16.2168. PMID: 14570952.
Strasberg SM. Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg. 2005 Oct.; 201(4):604-11. DOI: 10.1016/j.jamcollsurg.2005.04.032. PMID: 16183501.
Sváb J, Pesková M, Krska Z, et al. Prevence, diagnostika a chirurgická lécba poranĕní zlucovodů bĕhem laparoskopické cholecystektomie. Lécení poranĕní papily v důsledku invazivní endoskopie. Cást 1.--Prevence a diagnostika poranĕní zlucovodů [Prevention, diagnosis and treatment of iatrogennic lesions of biliary tract during laparoscopic cholecystectomy. Management of papila injury after invasive endoscopy. Part 1. Prevention and diagnosis of bile duct injuries]. Rozhl Chir. 2005 Apr.; 84(4):176-81. Czech. PMID: 15984144.
Stewart L, Robinson TN, Lee CM, et al. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg. 2004 Jul.-Aug.; 8(5):523-30; discussion 530-1. DOI: 10.1016/j.gassur.2004.02.010. PMID: 15239985.
Pereira R, Vo T, Slater K. Extrahepatic bile duct injury in blunt trauma: A systematic review. J Trauma Acute Care Surg. 2019 May; 86(5):896-901. DOI: 10.1097/TA.0000000000002186. PMID: 31008893.
de Reuver PR, Busch OR, Rauws EA, et al. Long-term results of a primary end-to-end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg. 2007 Mar; 11(3):296-302. DOI: 10.1007/s11605-007-0087-1. PMID: 17458601; PMCID: PMC1915638.
Ma D, Liu P, Lan J, et al. A Novel End-to-End Biliary-to-Biliary Anastomosis Technique for Iatrogenic Bile Duct Injury of Strasberg-Bismuth E1-4 Treatment: A Retrospective Study and in vivo Assessment. Front Surg. 2021 Oct. 28; 8:747304. DOI: 10.3389/fsurg.2021.747304. PMID: 34778361; PMCID: PMC8580848.
Mercado MA, Vilatoba M, Domínguez-Rosado I et al. Evolution of the repair of bile duct injury in a high-volume center in Latin America. J Gastrointest Surg. 2025 Dec.; 29(12):102233. DOI: 10.1016/j.gassur.2025.102233. Epub. 2025 Sep. 23. PMID: 40998153.
Sweigert PJ, Eguia E, Nelson MH, et al. Biliary Enteric Reconstruction After Biliary Injury: Delayed Repair Is More Costly Than Early Repair. J Surg Res. 2021 Jan.; 257:349-55. DOI: 10.1016/j.jss.2020.08.023. Epub. 2020 Sep. 3. PMID: 32892130.
Lopez-Lopez V, Kuemmerli C, Cutillas J, et al. Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama. Surgery. 2022 Oct.; 172(4):1067-75. DOI: 10.1016/j.surg.2022.06.020. Epub. 2022 Aug. 12. PMID: 35965144.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 О. В. ГРИНЕНКО
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
