Surgical management of iatrogenic biliary tract injuries following laparoscopic cholecystectomy: a systematic review

The aim was to analyse surgical management strategies and the main clinical outcomes in patients with iatrogenic biliary tract injuries following laparoscopic cholecystectomy; a systematic review was conducted in accordance with the recommendations of the PRISMA 2020 statement. The literature search covered publications from 2020 to 2026 available in PubMed/MEDLINE, the Cochrane Library, Scopus, Web of Science and Embase. Studies were included that involved adult patients with iatrogenic biliary tract injuries secondary to laparoscopic cholecystectomy, which described definitive surgical treatment and reported clinical outcomes. The selected studies showed heterogeneity regarding the timing of repair, characteristics of the injuries, reconstructive techniques and duration of follow-up. Roux-en-Y hepaticojejunostomy was the predominant reconstructive strategy, performed using the Hepp-Couinaud technique, with favourable outcomes in terms of patency and long-term surgical success. The findings showed that prior control of sepsis and local conditions constitute a relevant factor in determining the timing of reconstruction, whilst care provided by specialised teams was associated with better outcomes. The complications reported were bile leakage, anastomotic stenosis, cholangitis and the need for reoperation. It is concluded that biliary-enteric reconstruction constitutes a strategy for the definitive treatment of major lesions, although the methodological heterogeneity of the studies limits direct comparison between techniques and timing of repair.