الفهرس 
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Abstract
Bile duct injuries are frequently iatrogenic, being associated mainly
with surgery for gallbladder stones
Laparoscopic cholecystectomy soon replaced open cholecystectomy and is now considered as treatment of choice for symptomatic gall stones but the most important complications are bile duct injuries and bile leaks
It is estimated that more than 750,000 laparoscopic cholecystectomy procedures are performed annually in the United States; making it the most frequently performed abdominal procedure
Before Laparoscopic cholecystectomy became common treatment of gall bladder diseases, the number of open cholecystectomy cases in the US exceeded 700 000 cases per year and among them 0.2% comprised of biliary ducts
Numerous reports have demonstrated that the incidence of bile duct injuries has risen from 0.1%-0.2% to 0.4%-0.7% from the era of open cholecystectomy to the era of laparoscopic cholecystectomy. Major bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity and mortality, reduced long-term survival and quality of life, and high rates of subsequent litigation
A number of mechanisms causing biliary injury are postulated including an undue dissection in a distorted Calot’s triangle, use of diathermy close to bile ducts, local pathology such as acute and chronic inflammation with fibrosed gallbladder and excessive traction on the gall bladder
for investigating biliary leakage, laboratory parameters including; serum bilirubin, serum alkaline phosphatase, serum gammaglutamyltransferase and leucocytic count, are to be determined. Subsequently intra hepatic & extra hepatic bile ducts and liver parenchyma are to be evaluated by at least one imaging procedure
Any patient who has an atypical course following cholecystectomy should be suspected of having a bile duct injury and be worked up accordingly. Imaging techniques, such as ultrasound is extremely valuable during the initial evaluation of a patient suspected of having a biliary injury. ERCP can confirm the presence of a biliary injury and provides a means for definitively managing many injuries with temporary internal stents. If complete disruption or occlusion of the proximal bile duct is present, prompt evaluation with percutaneous transhepatic cholangiography (PTC) is necessary to define the biliary anatomy and decompress the biliary system
Noninvasive imaging techniques, such as magnetic resonance cholangiopancreatography (MRCP) can be used to evaluate bile duct injuries. CT cholangiography has also been shown to be an effective means of imaging the biliary tree
Endoscopic intervention can be safe and effective method of treatment in some cases and surgery can be the treatment of choice in other cases. However, management should be individualized based on factors such as presence of stone, stricture, ligature, or coagulopathy