Introduction
Bile duct injury, sepsis, friable oedematous non-dilated common bile duct, HighlightsEarly bile duct
ABDOMINAL SEPSIS, SEPSIS, COMPLICATIONS
HighlightsEarly bile duct injury reconstruction after sepsis control can be done safely at any time.It has comparable results for delayed reconstruction.It has decreased re-intervention and admission, total hospital stays, and total cost.It results in improved patient quality of life early.Bile duct injury (BDI) is one of the devastating complications of cholecystectomy procedures. It has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigationThe initial aim of BDI management is to control abdominal sepsis, followed by an assessment of BDITheoretically, intraoperative reconstruction of fresh injuries allows the best surgical outcomes. In most cases, this is not the usual scenario and is challenging to achieve either because only a limited number of BDIs are diagnosed intraoperatively or because the working surgeon lacks the necessary experience to carry out such a repairAdditionally, most surgeons prefer delayed reconstruction for BDI diagnosed postoperatively, attributing this to a less inflamed surgical site with an adequate vascularized duct stumpIn early reconstruction, the patient may be associated with sepsis and friable oedematous non-dilated common bile duct (CBD) stump, which is not practiced widely for fear of reconstruction failureUnfortunately, the literature is extremely poor on specific guidelines for the reconstruction time of major BDI. Many papers recently reported a significant association between adequate preoperative control of abdominal sepsis and the surgical reconstruction success rate, with no effect of reconstruction timeIn the absence of guidelines and patient medical knowledge and high rates of litigations and compensations, we believe that the decision for reconstruction time should be based on the predicted success, patient QoL, and the effective use of our low healthcare resources