Cholecystectomy Bile Duct Research Articles

Analysis of the risk factors, acute presentation, management and outcome associated with post cholecystectomy bile duct injury

Background: Cholecystectomy is one of the most common surgeries in the world. However, its complication has dangerous effects on the patient's health and economic status. It also increases the patient's morbidity and mortality. Objective was to investigate the risk factors, acute presentation, treatment, and outcome of bile duct injury after cholecystectomy. Methods: This prospective observational study included a total of 70 patients aged 18 years who underwent surgery for benign gallbladder disease. Malignancies of the gallbladder system, injury to the bile duct due to trauma, age >18 years or >70 years were excluded from the study. Various risk factors were queried preoperatively, intraoperatively, and postoperatively from patients and surgeons, and a conclusion was drawn. Results: Most patients were in the age group 31-50, namely 45 (64.28%). Of the total 70 patients, 20 (28.58%) were male and 50 (71.42%) were female. Total 06 (75%) patients have severe adhesion and 02 (25%) patients have mild adhesion. Of the total 70 patients, only 08 patients have the CALOTS triangle. Total 06 (8.57%) patients had no drainage and 64 (91.42%) patients had drainage. Total 52 (74.28%) most patients had pigtail drainage and 02 (2.85%) least patients had portal vein repair. Most patients were discharged after 54 (71.42%), 09 (12.85%) after discharge on patient request (DOPR), and the fewest patients, 02 (2.85%), were not discharged. Conclusions: In most cases, bile duct injury occurs after surgery for uncomplicated gallstone disease. Bile duct injury is associated with a variety of surgical complications and can be fatal. Bile duct injury is more common in women because gallstone disease is more common in women.

Post Cholecystectomy Bile Duct Injury in an Acute Setting: Categorization, Triaging, and Management Algorithm.

Background Postcholecystectomy bile duct injury (BDI) is a management challenge with significant morbidity, mortality, and effects on long-term quality of life. Early referral to a specialized hepatobiliary center and appropriate early management are crucial to improving outcomes and overall quality of life. In this retrospective analysis, we examined patients who were managed at our center over the past 10 years and proposed a triage and management algorithm for BDI in acute settings. Methods Patients referred to our center with BDI from January 2011 to December 2020 were reviewed retrospectively. The primary objective of initial management is to control sepsis and minimize BDI-related morbidity and mortality. All the patients were resuscitated with intravenous fluid, antibiotics (preferably culture-based), correction of electrolyte deficiencies, and organ support if required. A triage module and management algorithm were framed based on our experience. All the patients were triaged based on the presence or absence of bile leaks. Each group was further subdivided into red, yellow, and green zones (depending on the presence of sepsis, organ failure, and associated injuries), and the results were analyzed as per the proposed algorithm. Results One hundred twenty-eight patients with acute BDI were referred to us during the study period, and 116 patients had BDI with a bile leak and 12 patients were without a bile leak. Out of bile leak patients, 106 patients (91.38%) had sepsis with or without organ failure (red and yellow zone) and required invasive intervention in the form of PCD insertion (n=99, 85.34%) and/or laparotomy, lavage, and drainage (n=7, 6.03%). Another 10 patients (8.62%) had controlled external biliary fistula (green zone), of which four were managed with antibiotics, four underwent endoscopic retrograde cholangiopancreatography stenting, and only two (1.7%) patients could undergo Roux-en-Y hepaticojejunostomy upfront due to late referral. Among patients with BDI without bile leaks, nine (75%) had cholangitis (red and yellow zones). Out of these, five required PTBD along with antibiotics and four were managed with antibiotics alone. Only three (25%) patients in this group could undergo definitive repair without any restriction on the timing of referral and were sepsis-free at presentation (green zone). A total of nine patients had a vascular injury, and four of them required digital subtraction angiography and coil embolization. There were three (2.34%) mortalities; all were in the red zone of rest and had successful initial management. In total, five patients were managed with early repair in the acute setting, and the rest underwent definitive intervention at subsequent admissions after being converted to green zone patients with initial management. Conclusion The presented categorization, triaging, and management algorithm provides optimum insight to understand the severity, simplify these complex scenarios, expedite the decision-making process, and thus enhance patient outcomes in early acute settings following BDI.

Presentation Of Post Cholecystectomy Bile Duct Injuries In A Tertiary Care Hospital

Introduction:The occurrence of iatrogenic bile duct injuries is few, however potentially linked to life-threatening complications, particularly following the advent of laparoscopic cholecystectomy. Aims &Objectives: To evaluate the presentation of post-cholecystectomy bile duct injuries in a tertiary care hospital. Place and Duration of Study: This study was done in the Department of General Surgery at Combined Military Hospital Rawalpindi from Nov 2020 to Dec 2021. Material &Methods: This cross-sectional study was conducted on 15 subjects with post-cholecystectomy bile duct injuries.All the patients who presented to the emergency department and outdoor were included in the study and had post-cholecystectomy CBD injuries. Laparoscopic and open BDI were classified according to Strasberg classification. In descriptive statistics, mean, and standard deviation was used, and in qualitative analysis, frequency and percentages were calculated with the help of the SPSS 23 version, a p-value of? 0.05 was considered significant. Results: In our study, 5 (33.3 %) males and 10 (66.7 %) were females, with a mean age of 47.27 ± 4.79. The presentation on the admission of patients was as follows, 3 (20.0 %) patients had biloma, 4 (26.7 %) had jaundice, 2 (13.3 %) had abdominal pain, 1 (6.7 %) had external biliary fistula, 3 (20.0 %) had Biliary peritonitis and 2 (13.3 %) had a fever. Conclusion: The most common consequence of cholecystectomy was complete resolution, but bile leak and major duct damage cause considerable morbidity, death, and healthcare expenditures. Better outcome was achieved when a nonprimary and skilled hepatobiliary surgeon repaired severe bile duct damage.

Post cholecystectomy bile duct injury: a surgeon’s nightmare

Bile duct injury constitutes a major proportion of morbidity associated with cholecystectomy (laparoscopic>open). It has a lot of impact on patient health and subsequent medico-legal repercussions. Anatomical aberrations in the Calot's triangle anatomy is more common than meets the eye. A thorough understanding of anatomy, identification of the variant structures, Use of intraoperative cholangiogram and low threshold for conversion to open procedure could prove life-saving in many cases. Optimal timing of intervention has to be planned once the type of injury is identified. Minor leaks are usually managed with endoscopic interventions. More proximal leaks and complete transaction of bile duct usually require Roux En Y hepaticojejunostomy. The principal is to ensure complete drainage of all segments and prevention of sepsis. More grave scenarios like concomitant vascular injury, segmental atrophy and secondary biliary cirrhosis require referral to a tertiary centre and subsequent multidisciplinary approach. The aim of the study was to establish the true incidence, classification and management of bile duct injuries that could be life - saving in a few cases and career- saving in many others.

Management of Post Cholecystectomy Bile Duct Injury: Pertinent Factors Contributing to Good Surgical Outcomes

Objective: Surgical management remains the mainstay treatment for bile duct injury (BDI) post-cholecystectomy. Achieving long-term patency and lessening anastomotic failure depends on important factors including the types of repairs, timing of repairs, and surgical expertise. The present study focused on the impact of these factors on the surgical outcomes of BDI repair. Materials and Methods: Fifty-nine patients who were treated with BDI post cholecystectomy at the surgical department between January 2003 and December 2018 were retrospectively reviewed. The patients were categorized as 11 in-house and 48 referral patients, of which 22 patients had bile duct repairs prior to referral. Surgical outcomes and factors, including types of repairs, timing of repairs, and surgical expertise, impacting on the treatment results were analyzed. Results: The mean age of the patients was 47.6 years. The BDI incidence in the authors’ hospital was 0.14%. Complications occurred in 21 patients (35.6%), of which intraabdominal collection was the most common at 10 patients (16.9%). The median length of hospital stay was 16 days for in-house patients and 17 days for the referral group (p=0.542). The mortality rate was 1.7%. The overall patency was 93% with mean follow up 106.4 months. Concerning the primary patency rate, the partial segments IV/V liver resection and hepaticojejunostomy techniques had better long-term patency compared to primary repairs at 92.3% versus 37.5% (p=0.017), and biliary bypass at 92.3% versus 80% (p=0.44). BDI repairs performed by primary surgeons increased the risk of anastomotic failure in comparison to those done by hepatobiliary surgeons with 10-year patency at 53.3% versus 95.4% (p=0.014). Delayed repairs longer than six weeks after injury offered positive long-term outcomes compared to early repairs done within six weeks after injury, with a 10-year patency at 85.4% versus 31.3% (p<0.001). Conclusion: Delayed repair performed by the hepatobiliary surgeon with appropriate surgical techniques decreased anastomosis stricture and achieved good overall surgical outcomes in the management of post cholecystectomy BDI. Keywords: Bile duct injury; Cholecystectomy; Surgical management

A case from the future of HPB surgical oncology: resection of biliary tract cancer after immunotherapy.

Biliary tract cancers (BTCs) have limited response to systemic therapy and poor prognosis. Immunotherapy in BTCs has been investigated in recent years. Here, we report a case of locally advanced, unresectable gallbladder adenocarcinoma that progressed on chemotherapy. The patient was then treated with ipilimumab and nivolumab, which resulted in tumor shrinkage and autoimmune hepatitis, but established technical resectability. He underwent complete resection through extended right hepatectomy with en bloc cholecystectomy bile duct resection, hepatic and portal lymphadenectomy and Roux-Y hepaticojejunostomy reconstruction. The final pathology revealed a pathologic complete response. The scope of operative intervention after immunotherapy is still evolving for BTCs. Establishing resectability in tumors not susceptible to cytotoxic agents but responding to immunotherapy not only facilitates curative intent resection but also enhances the importance of infection prevention through operative stent-free long-term biliary decompression. Immunotherapy may also carry a unique risk profile for post-operative morbidity potential as in this case with autoimmune hepatitis.

Outcome of Post Cholecystectomy Bile Duct Injury Management in a High Volume Referral Center in Iran

Introduction: However more than a century pass from first cholecystectomy and iatrogenic bile duct injury, still this is a big problem, here we report our experience in a high volume referral center in Iran about handling of this complication. Methods: We collect data of 59 patient who referred us , suspected to post-cholecystectomy bile duct injury for 3 years since may 2016 both retrospectively through review of charts and calling them and prospectively by regular out-patient visit. Results: In this period 59 patients with age range of 20 to 74y/o referred our center, 15 male and 44 female. 21 patients underwent definite repair in 2 weeks from injury,17 patient after 2 weeks and before 6 weeks and 21 patients after 6 weeks. The most common presenting feature was bilious drain discharge, MRCP and ERCP was falsely negateive in 23.07% and 11.53% repsctively and the most reliable point was primary surgeon think of “something is wrong during surgery”.17% of patients had failed repair in original hospital and 33.9% had exploration ,irrigation and drainage.laboratory abnormality just in 66% of patients detected, most injuries was in Bismuth classII(18%),III(16%)and IV(16%),and Rt hepatic artery injury detected in 27(45.8%)patients.hepatectomy did in two patients and two patients died. No significant deference found when interval from injury to definite surgery compared between groups. Conclusion: Best decision for patients suspected to bile duct injury is referring to a high volume center at any time before exploration and with any interval from injury, HPB surgeon can go for repair.

Gallbladder metastasis of renal cell carcinoma presenting as a hypervascular polypoid lesion: case report of two cases with immunohistochemical analysis

BackgroundMetastasis of renal cell carcinoma (RCC) to the gallbladder is rare, and its clinicopathological feature remains poorly understood. We here present two cases of gallbladder metastasis from RCC presenting as a hypervascular polypoid lesion.Case presentationThe first case was a 73-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies detected a hypervascular polypoid lesion in the gallbladder 6 years after nephrectomy. Laparoscopic cholecystectomy was done. The pathological findings of the polypoid lesion showed proliferation of clear cells in the submucosal layer. Immunohistochemically, the tumor was positive for carbonic anhydrase 9 (CA9) but negative for cytokeratin 7 (CK7), suggestive of metastatic RCC. The second case was a 43-year-old man who had undergone right nephrectomy for clear cell RCC. Imaging studies revealed a hypervascular polypoid lesion of 20 mm in diameter in the gallbladder 1 year after nephrectomy. The patient underwent expanded cholecystectomy and extra-hepatic bile duct resection with lymphadenectomy. Microscopically, the polypoid lesion of the gallbladder was composed of clear cells in the submucosal layer. Immunohistochemical analysis showed positive staining for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) but negative staining for CK7, leading to the diagnosis of metastatic RCC.ConclusionsGallbladder metastasis from RCC is rare but should be considered when a hypervascular polypoid lesion in the gallbladder is detected during the follow-up period after RCC treatment.

Factors leading to loss of patency after biliary reconstruction of major laparoscopic cholecystectomy bile duct injuries: an observational study with long-term outcomes

BackgroundSmall sample size and a lack of standardized reporting for patients requiring reconstruction for laparoscopic cholecystectomy bile duct injuries (LC-BDI) have limited investigation of factors contributing to loss of patency. MethodsUsing a prospective database, patient characteristics, pre-repair investigations, Strasberg-Bismuth level of injury, timing of reconstruction and postoperative complications were compared in successful index reconstruction and revision patients. Multivariate analysis was performed to determine independent predictors of loss of patency. ResultsOf 131 patients analysed, 103 had a successful index reconstruction and 28 required revision. There were no statistically significant differences in patient characteristics between the two groups. Days to referral and reconstruction were significantly different (p < 0.001, p = 0.001). Patients with incomplete biliary imaging more often required a revision (p < 0.001). The only independent predictor of loss of patency was incomplete depiction of the biliary tree prior to initial reconstruction (p = 0.035, OR 10.131, 95% CI 1.180–86.987). Primary and secondary patency were 98.1% and 96.4%, respectively with no differences in 30-day complications. ConclusionsIncomplete depiction of LC-BDI before index reconstruction was independently associated with loss of patency requiring revision. Despite the complexity of repeat biliary reconstruction, outcomes in an HPB unit were similar to that of an index reconstruction.

One-stage laparoscopic versus two-stage endoscopic followed by laparoscopic treatment for cholecystolithiasis complicated with choledocholithiasis

Objective To compare the clinical efficacy of one-stage laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with primary suture (PS) versus two-stage endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy(EST) followed by LC in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods The clinical data of 171 patients with cholecystolithiasis complicated with choledocholithiasis, who underwent minimally invasive surgical treatment from January 2016 to December 2017, were retrospectively analyzed. Of these patients, 90 underwent one-stage LC+ LCBDE+ PS (the one-stage group), and 81 underwent two-stage ERCP/EST followed by LC (the two-stage group). The main clinical variables between the two groups of patients were compared. Results The surgical success rates (94.4% vs. 95.1%), residual stone rates (3.3% vs. 4.9%) and incidences of postoperative complications (6.7% vs.8.6%) showed no significant difference (all P>0.05) between the one-stage and two-stage groups. Compared with the two-stage group, the operative time was shorter (110.4 vs. 135.7 min), the length of postoperative hospital stay was shorter (3.3 vs. 7.1 d) and the total hospitalization cost was reduced (22 756.2 vs. 31 429.3 yuan) in the one-stage group. The incidence of long-term complications (2.2% vs.9.9%) in the one-stage group was also lower than that in the two-stage group (both P<0.05). Conclusions Both one-stage LC+ LCBDE+ PS and two-stage ERCP/EST+ LC are safe and effective in the treatment of cholecystolithiasis complicated with choledocholithiasis. One-stage LC+ LCBDE+ PS shows obvious advantages in hospitalization stay, hospitalization cost and in the preservation of function of the Oddi sphincter, and therefore should be the first choice in most cases. Key words: Cholecystolithiasis; Choledocholithiasis; Cholecystectomy, Laparoscopic; Cholangiopancreatography, endoscopic retrograde

Loss of patency after surgical repair of major laparoscopic cholecystectomy bile duct injuries: Contributing factors and long term outcomes

Loss of patency after surgical repair of major laparoscopic cholecystectomy bile duct injuries: Contributing factors and long term outcomes

The tangible consequences and intangible implications of laparoscopic cholecystectomy-associated bile duct injuries

When laparoscopic cholecystectomy (LC) was introduced more than two decades ago, alarming rates of bile duct injuries (BDIs) occurred in up to 0.4% of operations, twice as often as with open cholecystectomy, with only a recent decrease in incidence.1 Three contemporary studies from the National Health Service database in the UK and two statewide databases in the USA (New York and California), report laparoscopic cholecystectomy bile duct injury (LC-BDI) rates between 0.08–0.22%, which are comparable to open cholecystectomy, but these estimations may not accurately represent the true incidence of BDIs elsewhere.2-4

Post cholecystectomy bile duct injury: early, intermediate or late repair with hepaticojejunostomy – an E-AHPBA multi-center study

BackgroundTreatment of bile duct injuries (BDI) during cholecystectomy depends on the severity of injury and the timing of diagnosis. Standard of care for severe BDIs is hepaticojejunostomy. The aim of this retrospective multi-center study was to assess the optimal timing for repair of BDI with hepaticojejunostomy. MethodsMembers of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients with hepaticojejunostomy after BDI from January 2000 to June 2016. Patients were stratified according to the timing of biliary reconstruction with hepaticojejunostomy: early (day 0–7), intermediate (1–6 weeks) and late (6 weeks–6 months). Primary endpoint was re-intervention >90 days after the hepaticojejunostomy and secondary endpoints were severe 90-day complications and liver-related mortality. ResultsIn total 913 patients from 48 centers were included in the analysis. In 401 patients (44%) the bile duct injury was diagnosed intraoperatively, and 126 patients (14%) suffered from concomitant vascular injury. In multivariable analysis the timing of hepaticojejunostomy had no impact on postoperative complications, the need for re-intervention after 90 days nor liver-related mortality. The rate of re-intervention more than 90 days after the hepaticojejunostomy was significantly increased in male patients but decreased in older patients. Severe co-morbidity increased the risk for liver-related mortality (HR 3.439; CI 1.37–8.65; p = 0.009). ConclusionAfter BDI occurring during cholecystectomy, the timing of biliary reconstruction with hepaticojejunostomy did not have any impact on severe postoperative complications, the need for re-intervention or liver-related mortality. Individualised treatment after iatrogenic bile duct injury is still advisable.

Quality of Life Following Surgical Treatment of Post Cholecystectomy Bile Duct Injury.

The Roux-en-Y hepaticojejunostomy surgery provides the mainstay of treatment in cases of bile duct injury following cholecystectomy.The aim of this study is to assess the quality of life in patients who underwent surgical repair of bile duct injury following cholecystectomy. The prospective cross sectional study was conducted in Gastrointestinal Surgery Unit, Bir Hospital, National Academy of Medical Sciences. The cases of bile duct injury following cholecystectomy who underwent surgical repair from April 2013 to March 2018 were included. The data collection was done using SF-36 quality of life questionnaire tool.The study was conducted after ethical clearance from Institutional Review Board of National Academy of Medical Sciences. There were 26 cases of referred bile duct injury admitted in gastrointestinal surgery department from 2013 April till 2018 March out of which 19 (73%) were included in the study.More than half of the patients had limitations in carrying out vigorous activities (as running or lifting heavy objects) and 5.2% had a lot of limitations in carrying our moderate activities (as moving a table).63.1% of the patients did not have any interference with social activities with family, friends, neighbors or social groups because of their physical health or emotional problems. The surgical repair of bile duct injury following laparoscopic cholecystectomy has an impact on ability to perform work or daily activities as a result of physical health. However, it has little impact on patient's perception of general health and social activities.

Evolution of bile duct repair in a low and middle-income country (LMIC): a comparison of diagnosis, referral, management and outcomes in repair of bile duct injury after laparoscopic cholecystectomy from 1991 to 2004 and 2005–2017

BackgroundThere is a paucity of data from the developing world regarding laparoscopic cholecystectomy (LC) bile duct injuries (BDIs), despite the fact that most of the world's population live in a developing country. We assessed how referral patterns, management and outcomes after LC-BDI repair have evolved over time in patients treated at a tertiary referral center in a low and middle-income country (LMIC). MethodsPatients with LC-BDIs requiring hepaticojejunostomy were identified from a prospective database. Clinical characteristics, geographic distance from referral hospital, timing of referral and repair, and post-operative outcomes were compared in two cohorts treated during 1991–2004 and 2005–2017. ResultsOf 125 patients, 32 underwent repair in the early period, 93 in the latter. There was no difference in demographic or clinical characteristics, but a 45.6% increase in geographically distant referrals in the 2005–2017 period. Time from diagnosis to referral and referral to repair increased significantly (p = 0.031, p < 0.001), necessitating more intermediate repairs. Despite this, the number of severe complications decreased (p = 0.022) while long-term outcomes remained unchanged. ConclusionIn this study from an LMIC, geographic and logistic constraints necessitated deviation from accepted algorithms devised for well-resourced countries. When appropriately adapted, results comparable to those reported from developed countries are achievable.

Choledochodudenostomy for bile duct injuries: a less demanding option, in a demanding surgical situation

Cholecystectomy is one of the most common surgical procedure performed worldwide and therefore a common cause for iatrogenic biliary tract injury. Bile duct injuries are associated with significant morbidity and are a potentially fatal complication. Choledochodudenostomy in patients of post cholecystectomy bile duct injury can be done safely by experienced surgeons in CBD injuries distal to the confluence of the cystic and common hepatic duct after eradication of sepsis. Choledochoduodenostomy has its own technical advantages and it maintains the normal anatomy. As compared with a routine Roux-en-Y hepaticojejunostomy, CDD is technically easier, faster, requires less manipulation of the CBD, and is more physiological. We present a case report of a patient of laparoscopic cholecystectomy with CBD injury managed with choledochoduodenostomy who did extremely well after procedure with no immediate and delayed postoperative complication.

Clinical analysis of different treatment options for cholecysto-choledocholithiasis

Objective To evaluate the efficacy of different treatment options for cholecysto-choledocholithiasis (CCL), and try to find the ideal treatment. Methods From January 2006 to January 2016, a total of 3 107 patients with CCL from the Affiliated Hospital of Inner Mongolia Medical University were enrolled. Among them, 1 283 patients were in open cholecystectomy (OC) and open common bile duct exploration (OCBDE) group, 964 patients were in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) group, and 860 patients were in endoscopic retrograde cholangiopancreatography (ERCP)+ LC group. The clinical data of the three groups were analysed. One-way analysis of variance and chi-square test were performed for statistical analysis. Results From 2006 to 2010, the percentage of patients treated with OC+ OCBDE, LC+ LCBDE, and ERCP+ LC were 56.05%(829/1 479), 25.15%(372/1 479) and 18.80%(278/1 479), respectively; from 2011 to 2016, the percentage of patients received the above three treatments were 27.89%(454/1 628), 36.36%(592/1 628) and 35.75%(582/1 628), respectively. The difference in the proportion of the same treatment at different times was statistically significant (χ2=4.775, 4.168 and 0.669, all P 0.05). The hospital stay of the OC+ OCBDE group, the LC+ LCBDE group and the ERCP+ LC group were (6.7±1.3) days, (5.6±1.2) days and (10.9±1.6) days, respectively, and the differences were statistically significant (F=90.010, P<0.01). The hospitalization expenses of OC+ OCBDE group, LC+ LCBDE group and ERCP+ LC group were (13 720±1 910) yuan, (18 150±1 490) yuan and (25 830±2 430) yuan, respectively, and the differences were statistically significant (F=302.991, P<0.01). Conclusion The first choice of patients with CCL is endoscopic minimally invasive treatment and open surgery can be used as a remedial method for endoscopic treatment. Key words: Cholecysto-choledocholithiasis; Endoscopic minimally invasive treatment; Open surgery

Laparoscopic repair of post – cholecystectomy bile duct injury

Laparoscopic repair of post – cholecystectomy bile duct injury

E-AHPBA multicentre study: post cholecystectomy bile duct injury: early vs late repair with hepaticojejunostomy

E-AHPBA multicentre study: post cholecystectomy bile duct injury: early vs late repair with hepaticojejunostomy

The management of benign biliary strictures

The most common cause of Benign Biliary Stricture is post cholecystectomy bile duct injury. Following introduction of the laparoscopic cholecystectomy procedure the incidence of bile duct injury and stricture has increased. The studies suggest that the incidence remained stable even after the improved learning curve. The early diagnosis and prompt management is the key in preventing devastating sequelae of this benign condition. The management of post cholecystectomy biliary strictures involves a multidisciplinary approach. Our review aims to describe the present strategy in management of post cholecystectomy biliary strictures.