An endoscopic approach to the management of surgical bile duct injuries: nine years' experience.
BACKGROUND
The evaluation of the endoscopic treatment of surgical bile duct injuries, especially in the management of post-operative strictures, remains controversial.


OBJECTIVE
The aim of this study was to evaluate the feasibility of using endoscopic management from a study of the clinical reports of two of the main endoscopy units in Sicily.


METHODS
A total of 137 consecutive patients were selected. There were 85 simple biliary fistulas: 64 from the cystic duct stump; 19 from the gall bladder bed; and two from intra-hepatic bile ducts. There were 52 biliary lesions: 15 complete transections; 12 incomplete lesions of the common bile duct with six associated strictures; five complete or incomplete sections of the right antero-medial duct; and 20 incomplete strictures (without leak).


RESULTS
The success rate was 96.3% for simple biliary fistulas. Endoscopic therapy was feasible only in 40.6% of lesions of the common bile duct or the right antero-medial duct (13/32), but with 100% success. In the case of strictures (with or without associated leak), there was a good outcome in 88.2% of patients who completed the therapeutic procedure.


CONCLUSIONS
Endoscopic management of simple biliary fistulas and incomplete lesions of the common bile duct is the preferred approach. If continued for 12-24 months, with the placement of three or more 10F stents, the management of stenoses is guaranteed to yield good results.
Familiari
L
L
Digestive Endoscopy Unit, Department of Medicine and Pharmacology, University of Messina, Messina, Italy. familiari_endoscopia@libero.it
Scaffidi
M
M
Familiari
P
P
Consolo
P
P
Ficano
L
L
Micelic
D
D
Martorana
G
G
Tarantello
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D016896:Treatment Outcome