Treatment of Bile Duct Transection Injury in an Integrated System.

INTRODUCTION

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures in the United States. Despite widespread adoption of safety measures, bile duct injury remains a serious complication and is associated with substantial morbidity and health care costs.

METHODS

The authors conducted a retrospective cohort study of patients treated for bile duct transection within Kaiser Permanente Northern California, an integrated health care system, between August 2019 and November 2025. All repairs were performed by hepatopancreatobiliary (HPB) surgeons at designated Centers of Excellence. Data were extracted from a unified electronic medical record and analyzed using descriptive statistics.

RESULTS

Among approximately 60,000 laparoscopic cholecystectomies performed during the study period, 25 patients sustained Strasberg E1-E5 injuries requiring surgical repair (incidence: 0.043%). The mean age was 61 years; 52% were male. Most injuries (68%) were recognized intraoperatively. Fifteen patients (60%) underwent early repair (< 2 weeks), while 10 required delayed reconstruction due to vascular injury, biliary sepsis, or severe inflammation. E2 and E3 injuries accounted for 80% of cases. Mean follow-up was 39 months; 1 patient (4%) developed an anastomotic stricture successfully treated endoscopically. No postoperative bile leaks occurred.

CONCLUSION

In an integrated health care system with daily HPB surgeon availability, early recognition and repair of bile duct injury were feasible and associated with favorable short-term outcomes. Vascular injury remains a key determinant of repair complexity and long-term success. Structured intraoperative strategies and timely referral to experienced HPB surgeons are essential to optimize outcomes. Future research should evaluate long-term functional results.