title: Right and left partial iatrogenic injuries of the biliary tree. Therapeutic options.
abstract: BACKGROUND
  Bile duct injuries (BDI) have a wide array of presentation. Left partial injuries (Strasberg D) of the hepatic duct are the result of excessive traction, which dissects the hepatic hilum and provokes medial perforations without continuity loss. Right partial injuries (Strasberg A, B and C) are produced by direct damage to the hepatic duct or isolated injury to the right and accessory ducts. It is important to determine frequency, spectrum and treatment outcome of this BDI in the surgical scenario.
  
  
  METHODS
  Patients with BDI who underwent surgical treatment in our hospital were reviewed, right and left partial injuries were selected. Demographic, clinical and therapeutic data were analyzed.
  
  
  RESULTS
  In a 16-year period, 405 patients underwent surgical treatment of BDI. 31 (8%) were classified as a left partial injury (Strasberg D): 23 injuries at the common hepatic duct treated with a Hepatojejunostomy (HJ); four at the confluence level which received a HJ with neoconfluence construction; two partial injuries in the left hepatic duct underwent a selective left HJ; and two complete occlusions of the left hepatic duct, one treated with a partial hepatectomy and the last case underwent a partial HJ. Right partial injuries (Strasberg A, B or C) were identified in 21 cases (5%), their treatment was tailored according to the type of BDI (conservative, selective HJ, or hepatectomy).
  
  
  CONCLUSIONS
  In our series the frequency of left and right partial BDI injuries was 8% and 5%, respectively. The spectrum of analyzed injuries included four subtypes for the left partial and eight for the right partial lesions. Most BDI in the two analyzed groups presented concomitant devascularization of the extra-hepatic ducts, therefore receiving surgical treatment rather than endoscopic treatment was done.
authors.affiliation: Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, DF México. miguel.mercadod@quetzal.innsz.mx
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mercado
authors.forename: Ismael
authors.initials: I
authors.lastname: Domínguez
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Arriola
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramirez-Del Val
authors.forename: Miguel
authors.initials: M
authors.lastname: Urencio
authors.forename: Norberto
authors.initials: N
authors.lastname: Sánchez-Fernández
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D003663:Decision Trees; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D055815:Young Adult