Introduction: Iatrogenic bile duct injuries (IBDI) with loss of confluence are understood as those where right and left hepatic ducts lose continuity with the common biliary tree. Material & Methods: This is an observational study conducted in the department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. over a period of 2 years from Jan 2017 to Dec 2018. All patients diagnosed with IBDI with loss of confluence determined transoperatively and treated with any bilioenteric derivation were included. Results: In the period of time considered for the present study, a total of 55 bile duct complex injuries were repaired (Strasberg E: 1 – E5), from them, 10 (18.1%) were injuries with loss of confluence. During long term observation, 2 patients presented biliary stenosis (20%), from these, 1 case were managed with progressive dilatations through a percutaneous catheter; one case was considered successful (10%) with catheter removal without clinical or biochemical cholestasis, and 1 cases (10%) are still in dilatation process. Conclusions: Iatrogenic bile duct injuries with ductal separation can be managed with single hepatojejunostomy with good results. Preplaced ductal catheter can be helpful in ductal identification. Post HJ anastomotic stricture can be managed with percutaneous dilatation as a first therapeutic intention.

Introduction: Iatrogenic bile duct injuries (IBDI) with loss of confluence are understood as those where right and left hepatic ducts lose continuity with the common biliary tree. Material & Methods: This is an observational study conducted in the department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. over a period of 2 years from Jan 2017 to Dec 2018. All patients diagnosed with IBDI with loss of confluence determined transoperatively and treated with any bilioenteric derivation were included. Results: In the period of time considered for the present study, a total of 55 bile duct complex injuries were repaired (Strasberg E: 1 – E5), from them, 10 (18.1%) were injuries with loss of confluence. During long term observation, 2 patients presented biliary stenosis (20%), from these, 1 case were managed with progressive dilatations through a percutaneous catheter; one case was considered successful (10%) with catheter removal without clinical or biochemical cholestasis, and 1 cases (10%) are still in dilatation process. Conclusions: Iatrogenic bile duct injuries with ductal separation can be managed with single hepatojejunostomy with good results. Preplaced ductal catheter can be helpful in ductal identification. Post HJ anastomotic stricture can be managed with percutaneous dilatation as a first therapeutic intention.