RT Journal
A1 Hines O, Reber HA
T1 Invited critique: Operative repair of bile duct injuries involving the hepatic duct confluence
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD July 1
VO 134
IS 7
SP 775
OP 775
DO 10.1001/archsurg.134.7.775
UL http://dx.doi.org/10.1001/archsurg.134.7.775
AB 
As the authors suggest, the early management of these patients should focus on accurate delineation of the injury, control of infection (cholangitis and/or abscess), and drainage of the bile. Biliary drainage may be external via a surgically placed drain, or through a transhepatic tube inserted by the radiologist when a transhepatic cholangiogram is done. If the obstruction is incomplete, it may even be possible to pass the stent through the injured area into the duodenum, which is desirable. In patients who have experienced significant inflammation or infection at the time of the initial injury, we recommend a 3- to 6-month wait before definitive repair, provided that intubation relieves the obstruction and controls cholangitis.