CBD Injury During Cholecystectomy: Prevention, Early Recognition, Management and Ethical Disclosure

Abstract

Common bile duct (CBD) injury remains one of the most feared complications of cholecystectomy. Although uncommon, its consequences may be devastating when recognition is delayed or when repair is attempted without adequate expertise. This manuscript summarises the key deliberations of a surgical panel discussion on CBD injury, with emphasis on prevention, intra-operative warning signs, classification-based management, post-operative detection, delayed repair, referral principles and ethical disclosure to attendants. The central message is that most bile duct injuries arise from misinterpretation of anatomy rather than lack of knowledge. Prevention therefore depends on disciplined adherence to safe cholecystectomy principles, including B-SAFE orientation, identification of Rouviere’s sulcus or the R4U line, proper dissection of the hepatocystic triangle, demonstration of the critical view of safety and an intra-operative pause whenever anatomy is uncertain. If injury is suspected, the surgeon should classify the injury, avoid hazardous repair, drain when necessary and refer early to a centre with hepatobiliary expertise. Early recognition, minimal intervention and timely referral remain the cornerstones of good outcomes.