Endoscopic management of persistent biliary leakage resulting from complete transection of the bile duct at cholecystectomy.
OBJECTIVE
Injuries to the bile duct are not uncommon during cholecystectomy. While minor injuries are amenable to endoscopic therapy, major ones, such as complete transection of the duct, require surgical intervention. We report on the endoscopic management of such injuries.


METHODS
We included in the study ten patients who had persistent postoperative bile drainage (either through a surgically placed catheter or through a biliocutaneous fistula) after their cholecystectomy procedure had been complicated by complete transection of the bile duct. Plastic biliary endoprostheses were placed in the bilioma through the papilla of Vater. In one patient, both the right and the left hepatic ducts were opacified by injecting contrast material through the drainage catheter and it was possible to place stents in both the ducts.


RESULTS
All the patients improved clinically after the procedure. In one patient the stent became dislodged and an elective Roux-en-Y hepaticojejunostomy was performed, but it was possible to remove the stents from all the other patients. Two patients were referred for surgery but in both cases the bile flow through the bile duct was shown to be so good on nuclear imaging that they were not operated on. All the non-operated patients are well after a mean +/- SD follow-up of 22.3 +/- 5.5 months.


CONCLUSIONS
Placement of biliary stents in the bilioma is a useful adjunct to percutaneous drainage in patients with complete transection of the bile duct. After placement of a biliary stent in the bilioma the percutaneous drainage catheter may be removed. In one of our study patients it was also possible to place stents in the intrahepatic ducts and the bile duct was reconstructed. Long-term follow-up of these patients and further studies are required to assess the role of endoscopic management as an alternative to surgery in patients with this condition.
Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, India. spmisra@sancharnet.in
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SP
Misra
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Dwivedi
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery; D003549:Cystic Duct / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019919:Prosthesis Implantation / Q000295:instrumentation*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome