REVIEW ARTICLE Treatment of the iatrogenic lesion of the biliary tree secondary to laparoscopic cholecystectomy: a single center experience Alessandro Tropea 1 • Duilio Pagano 1 • Antonio Biondi 2 • Marco Spada 1 • Salvatore Gruttadauria 1 Received: 5 February 2016 / Accepted: 8 February 2016 Ó Italian Society of Surgery (SIC) 2016 Abstract Surgical bile duct injury (SBDI), during laparoscopic cholecystectomy, is a worldwide ongoing problem. The purpose of this study is to analyze a single center retrospective experience with this topic. From 1999 to 2012, 30 patients with diagnosis of SBDI after laparo- scopic cholecystectomy performed in other institute for gallbladder lithiasis and then transferred to our facility were enrolled in this analysis. We considered in the study the following parameters: classification and site of the bile duct injury, infective complications and therapeutic man- agement according to early or late referral. Twenty four patients (80 %) had a SBDI type E1; a concomitant vas- cular injury was described in 3/30 (10 %) in right hepatic artery. 11 patients had HJJ as primary surgical treatment in our hospital. Surgical site infection was documented in 9/30 (30 %). The most common micro-organisms docu- mented in SSI were E. coli with an incidence of 55.5 % of SSI. Worse infective complications were detected in the late referral group. Complex SBDI occurred during laparoscopic cholecystectomy should be early referred to advanced hepatobiliary program, for appropriate multidis- ciplinary management. Keywords Gallbladder lithiasis Á Surgical bile duct injury Á Percutaneous transhepatic cholangiography Á Endoscopic retrograde cholangiopancreatography Introduction Cholecystectomy is one of the most commonly performed abdominal surgical procedures throughout the world, 96 % are performed as a laparoscopic procedure with a conver- sion rate of 7.6 % [1–3]. Bile duct injury is defined as any clinically damage to the biliary system including cystic duct and intra or extra- hepatic biliary ducts. These injuries most frequently develop serious consequences for patients, which may include leaks, strictures, transactions or ligation of major bile duct, postoperative fluid collection, biliary peritonitis, sepsis, biliary cirrhosis and hepatic or multiple organ failure [4, 5]. Before laparoscopy, the incidence of major bile duct injury after cholecystectomy was thought tobe fairly steady at about 1/300 (0.3 %) procedures [6, 7]. The incidence of biliary lesions after laparoscopic cholecystectomy (LC) has shown to be associated with an increased risk of surgical bile duct injury (SBDI), up to threefold higher than open procedure with an incidence of 1/200 (0.5 %) cholecystectomies [8, 9]. There are several pathological conditions that predis- pose to bile duct injury which include acute cholangitis, gangrenous cholecystitis, perforated gallbladder, polycystic disease of liver, sclero-atrophic gallbladder, Mirrizi’s syndrome, duodenal ulcer, pancreatic or hepatic neoplasm, pancreatitis, fibrosis in Calot’s triangle, obesity, hemor- rhage, anatomical biliary variations, presence of anomalous duct and/or vessels [10–12]. & Salvatore Gruttadauria sgruttadauria@ismett.edu 1 Unit of Abdominal Surgery and Organ Transplantation, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), University of Pittsburgh Medical Center, Via E. Tricomi 5, 90127 Palermo, Italy 2 Department of Surgery, University Hospital ‘‘Policlinico- Vittorio Emanuele’’, Catania, Italy 123 Updates Surg DOI 10.1007/s13304-016-0347-2