The incidence of bile duct injury post laparoscopic cholecystectomy ranges from 0.4 to 0.6% and increases in conditions like acute cholecystitis, chronic cholecystitis and in cases of altered anatomy of the biliary tree. Bile duct injury after a laparoscopic cholecystectomy generally present as biliary fistula if drain is placed or as bilioma presenting as abdomen distention and ileus if drain not placed or as obstructive jaundice when there is complete clipping and transection of bile duct. Patients with active bile leak present in immediate postoperative period with abdomen distention, inability to pass flatus/ stools, poor appetite, fever and bile tinged drain output when drain in place. In the initial postoperative period when the patient presents as bilioma, it will require drainage with placement of percutaneous drains. Immediate bile duct repair is possible in the initial 72 to 96 hours after which the chances of suture takeup is poor. and therefore in patients presenting beyond 96 hours of bile duct injury, drainage of biliary collection is done and biliary fistula is allowed to heal and a delayed repair of bile duct duct (after 3months) is done. By delaying the bile duct repair, it allows the upstream dilatation of bile duct and therefore a better repair. The proposed surgery for a bile duct stricture post laparosocpic cholecystectomy is hepaticojejunostomy. The hepaticojejunostomy should be wide (1.5 to 2 cms), draining all the ducts adequately. HJ is done using PDS or Maxon with tension free interrupted sutures.
