title: Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvous.
abstract: BACKGROUND
  Complete transection of the common bile duct (CBD) is a dramatic and often extremely difficult-to-repair event after surgery. Abdominal biliary fluid collection or jaundice is the initial symptom, and ERCP is the determinant for diagnosis.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of a combined endoscopic-radiologic technique for the reconstruction of the CBD.
  
  
  METHODS
  Single-center retrospective study.
  
  
  METHODS
  Tertiary-care center for biliary surgery.
  
  
  METHODS
  This study involved 22 patients with complete transection of the CBD after cholecystectomy.
  
  
  METHODS
  A guidewire is passed in the subhepatic space through the endoscopic approach. A snare loop is advanced from the percutaneous entry site to catch the free end of the wire and then pulled outside the body: a percutaneous biliary-duodenal (PTBD) drainage is put in place. After a new contralateral PTBD, 4 plastic stents are inserted. The stents are removed endoscopically after 8 to 12 months.
  
  
  METHODS
  Success of the rendezvous maneuver, patient recovery, and patient mortality.
  
  
  RESULTS
  After a mean follow-up period of 4 years, 16 patients are asymptomatic. Two patients are still under treatment, and 4 patients underwent surgery, as was the surgeon's choice.
  
  
  CONCLUSIONS
  Single-center, retrospective study with a small population.
  
  
  CONCLUSIONS
  Interruption of the biliary tree does not represent an indication for an often-difficult surgical treatment, because the CBD is often thin in the presence of biliary peritonitis. However, the condition can be treated with a rendezvous technique. Surgery can be performed in elective conditions or completely avoided when conservative therapy is selected.
authors.affiliation: Department of Surgical Sciences and Organ Transplantation-P. Stefanini, University La Sapienza of Rome, Rome, Italy. fausto.fiocca@uniroma1.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Fiocca
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Salvatori
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Bruni
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ceci
authors.forename: Mario
authors.initials: M
authors.lastname: Corona
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Donatelli
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome