The prophylactic and management strategy for the biliary injury after hepatectomy        SHEN Feng, YAN Zhen-lin. Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Corresponding author: SHEN Feng, E-mail:shenfengdfgd@yahoo.com.cn
Abstract    Biliary injury is a major complication in the process of hepatectomy. The clinical manifestation of biliary injury is quite different from that from cholecystectomy. The main presentations of biliary injury after hepatectomy are bile leakage, obstructive jaundice and biliary bleeding. The biliary injury is strongly associated with the type of the hepatectomy procedure, especially when the resection of the liver is associated with the segment 4. When the lesion is located in segment 4, careful preoperative preparations is a must, asking for the careful interpretation of the imaging data. Preoperative ultrasonography is recommended for its convenience of usage and will be helpful for the selection of the cutting surface of the hepatic lesion. Bile leakage is the most commonly seen after hepatectomy, and the drainage is the first choice for patients in case of bile collection in the abdominal cavity or even abscess formation. Biliary decompression is recommended when the bile leakage is suspected or documented. Surgery is indicated for some patients when the bile drainage is cut from the intestinal passage or the mechanic obstruction is overt.