Surgical strategies for the management of traumatic benign stricture of high bile duct

Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality, reduced long term survival rate and poor quality of life. For most major BDIs (Strasberg classification E1 E4), the recommended method of repair is hepaticojejunostomy (HJ). We conducted a retrospective review aiming to examine the surgical technique of high HJ at our institution. This review highlights 4 aspects in the operation which include the hepatoduodenal ligament exposure, hepatic artery and its branches protection, exposing the intrahepatic bile duct above the stricture plane, and HJ techniques. Overall, the optimal long term result of surgical management depends on the availability of experienced hepatobiliary surgeons and a considerable large HJ anastomosis above the stricture.