title: Endoscopic management of post-cholecystectomy biliary fistula.
abstract: OBJECTIVE
  Bile duct injury is an uncommon but potentially serious complication in cholecystectomy. A recognized treatment for minor biliary injury is internal biliary decompression by endoscopic retrograde cholangiopancreatography (ERCP) and stent insertion. The aim of this study was to assess the effectiveness of ERCP in the management of minor biliary injuries.
  
  
  METHODS
  A retrospective review of medical records at a tertiary referral centre identified 36 patients treated for postoperative minor biliary injuries between 2006 and 2010. Management involved establishing a controlled biliary fistula followed by ERCP to confirm the nature of the injury and decompress the bile duct with stent insertion.
  
  
  RESULTS
  Controlled biliary fistulae were established in all 36 patients. Resolution of the bile leak was achieved prior to ERCP in seven patients, and ERCP with stent insertion was successful in 27 of the remaining 29 patients. Resolution of the bile leak was achieved in all patients without further intervention. The median time to resolution after successful ERCP was 4 days. Two patients underwent ERCP complicated by mild pancreatitis. No other complications were seen.
  
  
  CONCLUSIONS
  This review confirms that postoperative minor biliary injuries can be managed by sepsis control and semi-urgent endoscopic biliary decompression.
authors.affiliation: Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia. mickhii@gmail.com
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hii
authors.forename: David E
authors.initials: DE
authors.lastname: Gyorki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sakata
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cade
authors.forename: Simon W
authors.initials: SW
authors.lastname: Banting
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D001658:Biliary Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation; D002763:Cholecystectomy / Q000009:adverse effects*; D003664:Decompression / Q000295:instrumentation / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult