Invited Commentary

Stewart and Way analyzed 90 patients with laparoscopic bile duct injuries with respect to total duration of illness. Only 18% of the initial attempts at repair and 0% of second attempts at repair by the initial surgeon were successful. In contrast, 94% of the repairs performed by very experienced biliary tract surgeons were successful. A primary end-to-end repair over a T tube was unsuccessful in every case of the classic bile duct injury,¹ and balloon dilatations uniformly were unsuccessful. The authors conclude that surgeons who specialize in the repair of bile duct injuries achieve much better results than those with less experience. Nonsurgical treatment is generally unsuccessful. Both unsuccessful methods substantially increase the duration of disability.

One might challenge these data by saying that the data are self-serving, that the tertiary surgeon only sees the failures, and that most injuries in the community are repaired successfully there. The latter