To explore the clinical efficacy of different treatment methods for the same classification of iatrogenic bile duct injury (IBDI).

A retrospective analysis was carried out including the clinical data of 34 patients with Ⅱ 1 type IBDI admitted to the First Affiliated Hospital of Xinjiang Medical University from October 2017 to February 2022. The patients were divided into the endoscopic group (13 cases) and the surgical group (21 cases) according to different treatment methods. The hospitalization days, hospitalization expenses, laboratory examination indicators before and after surgery, intraoperative bleeding, operation time, postoperative complications, and follow-up after discharge were compared between the two groups.

The total bilirubin and direct bilirubin levels in the endoscopic group on the first day after surgery were lower than those in the surgical group, and the operation time, intraoperative bleeding, hospitalization days, and hospitalization expenses were lower than those in the surgical group, with statistically significant differences (all P<0.05). There was no statistically significant difference in repair timing between the two groups (χ²=0.095, P>0.05). The patients were followed up for 33.2 (6.4-67.7) months, with a follow-up effective rate of 97.1%. Among the short-term complications, 9 patients with Clavien-Dindo≥Ⅲ were in the surgical group. Follow-up effect Terblanche rating: in the endoscopic group, 9 cases were excellent, 3 cases were good, and 1 case was poor; in the surgical group, 16 cases were excellent, 3 cases were good, and 2 cases were poor. There was no statistically significant difference in long-term efficacy between the two groups (χ²=0.051, P>0.05).

The treatment of Ⅱ 1 type IBDI may be determined based on the specific situation of the injury. Endoscopic therapy has the advantages of minimally invasive surgery, short operation time, and rapid postoperative recovery. However, long-term and repeated stent replacement increases treatment costs, hospital stays, and complications. Surgical treatment is still the first choice when bile duct transection and vascular injury are immediately detected during IBDI surgery.