Vasculobiliary Injury in Laparoscopic and Open Cholecystectomy HPB | 2026

Introduction

Vasculobiliary injury is one of the most serious complications associated with cholecystectomy, particularly when a bile duct injury is accompanied by injury to the hepatic artery or portal vein. These combined injuries are clinically important because vascular compromise can worsen the biliary injury, extend its level, impair healing after reconstruction, and in severe cases lead to liver ischemia, infarction, abscess formation, or hepatic atrophy. This review was undertaken to clarify the definition of vasculobiliary injury, examine its mechanisms, and outline its clinical implications and management.

Summary

This review defines vasculobiliary injury as a combined injury involving both a bile duct and a hepatic artery and/or portal vein, with the bile duct damage resulting from operative trauma, ischemia, or both. The authors show that the most common form is injury to the right hepatic artery associated with bile duct injury. In these cases, arterial damage may silently worsen the biliary injury by making it extend higher than the gross mechanical injury initially suggests. The review also highlights that right hepatic artery injury rarely causes major problems when isolated, but becomes clinically significant when combined with bile duct injury because collateral blood flow is disrupted. This combination increases the risk of biliary ischemia, anastomotic failure, restricture, and in about 10% of patients, slow infarction of the right liver. Injuries involving the portal vein or the proper or common hepatic artery are much rarer but far more dangerous, often leading to rapid hepatic necrosis and high mortality. The authors recommend routine vascular imaging when early biliary repair is being considered and advise that patients with portal vein or major hepatic artery injuries should be referred urgently to tertiary hepatopancreatobiliary centers.

Conclusion

The key clinical message of this review is that vasculobiliary injury should not be viewed as a simple extension of bile duct injury, but as a distinct and more dangerous entity that demands early recognition, careful vascular assessment, and specialized management. Right hepatic artery injury is the commonest pattern, whereas portal vein and major hepatic artery injuries are the most devastating. The review strongly supports delayed biliary reconstruction in selected ischemic injuries and emphasizes referral to expert centers for optimal outcomes.