Biliary: bile duct injury repair: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Biliary: bile duct injury repair

Sample item

During laparoscopic cholecystectomy for acute cholecystitis, the surgeon realises that the common bile duct has been completely transected (Strasberg E injury) and bile is leaking. The surgeon is not a hepatobiliary specialist. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Convert, place drains and refer for Roux-en-Y hepaticojejunostomy by a specialist team

A complete transection of the bile duct needs a tension-free biliary-enteric anastomosis, usually a Roux-en-Y hepaticojejunostomy, performed by an experienced hepatobiliary surgeon. Control of bile leak with drainage and transfer to a specialist unit gives better long-term outcome than an inexperienced immediate repair. End-to-end repair of a transected duct has a high rate of stricture.

Option by option

  • A. Ligate the proximal duct and close the abdomen

    Ligating the proximal duct causes biliary obstruction, cholangitis and secondary biliary cirrhosis.

  • B. Convert, place drains and refer for Roux-en-Y hepaticojejunostomy by a specialist team (correct)

    Correct. Drainage then hepaticojejunostomy by experienced hands is the accepted management of a transected duct.

  • C. Continue the operation and review the patient in 6 weeks

    A known bile leak left unaddressed causes biliary peritonitis and sepsis within days.

  • D. Primary end-to-end duct repair over a T-tube immediately

    Primary end-to-end repair of a transected duct is prone to ischaemic stricture and is not advised.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Convert, place drains and refer for Roux-en-Y hepaticojejunostomy by a specialist team. A complete transection of the bile duct needs a tension-free biliary-enteric anastomosis, usually a Roux-en-Y hepaticojejunostomy, performed by an experienced hepatobiliary surgeon.

Why is "Ligate the proximal duct and close the abdomen" not the answer?

Ligating the proximal duct causes biliary obstruction, cholangitis and secondary biliary cirrhosis.

Why is "Continue the operation and review the patient in 6 weeks" not the answer?

A known bile leak left unaddressed causes biliary peritonitis and sepsis within days.

Why is "Primary end-to-end duct repair over a T-tube immediately" not the answer?

Primary end-to-end repair of a transected duct is prone to ischaemic stricture and is not advised.

What concept does this question test?

It tests Biliary: bile duct injury repair in General Surgery. Control of bile leak with drainage and transfer to a specialist unit gives better long-term outcome than an inexperienced immediate repair. End-to-end repair of a transected duct has a high rate of stricture.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Biliary: bile duct injury repair?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.