What surgical procedure is typically needed for a major common bile duct injury?

In the case of a major common bile duct injury, the preferred surgical procedure is a Roux-en-Y hepaticojejunostomy. This technique is utilized to establish an anastomosis between the common bile duct and the jejunum, effectively bypassing the injured segment and allowing bile to drain directly into the small intestine.

The Roux-en-Y configuration is particularly advantageous because it helps to prevent complications such as biliary obstruction and offers a low incidence of reflux. This approach is also beneficial for preserving the function of the biliary tree and minimizing the risk of postoperative cholangitis. The construction of a Roux limb provides a stable and reliable pathway for bile drainage, which is crucial in addressing the challenges associated with major bile duct injuries.

In comparison, the other procedures listed, such as hepaticoduodenostomy, choledochoduodenostomy, and duodenojejunostomy, are generally less favorable in these scenarios either due to increased risk of complications or because they do not adequately correct the issue while maintaining normal bile flow. Therefore, Roux-en-Y hepaticojejunostomy stands out as the optimal strategy for managing significant injuries to the common bile duct.