Abstract
Iatrogenic bile duct injury after cholecystectomy remains a serious complication, particularly in proximal lesions involving the hepatic duct confluence. In complex cases associated with lobar atrophy, vascular compromise, or septic complications, biliary reconstruction alone may be insufficient, and liver resection becomes necessary. A retrospective study was conducted at the Syzganov National Research Center of Surgery between March 2019 and November 2025. Four patients with proximal and complex bile duct injury after cholecystectomy requiring liver resection were included. Injury severity was classified according to the Strasberg classification. Indications for hepatectomy included severe lobar atrophy, persistent external biliary fistula, intrahepatic suppurative complications, vascular involvement, and failure of previous interventions. Postoperative outcomes were assessed, and complications were graded according to the Clavien–Dindo classification. Biliary-enteric reconstruction was required in two cases. The mean hospital stay was 9 days (range 6–13). No grade III–V complications or mortality were observed. This unique case demonstrates that in patients with complex proximal bile duct injury, anatomical liver resection performed in a specialized hepatopancreatobiliary center is a safe and effective treatment option, providing favorable short-term outcomes and long-term bile duct patency.