title: Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era.
abstract: Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.
authors.affiliation: II Unit of General Surgery, Luigi Sacco Hospital, Department of Biochemical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Crespi
authors.affiliation: II Unit of General Surgery, Luigi Sacco Hospital, Department of Biochemical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Montecamozzo
authors.affiliation: II Unit of General Surgery, Luigi Sacco Hospital, Department of Biochemical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Foschi
references.citation: Ann Chir. 2000 Sep;125(7):654-9
references.pmid: 11051695
references.citation: Arch Surg. 2005 Oct;140(10):986-92
references.pmid: 16230550
references.citation: Surgery. 1993 Oct;114(4):806-12; discussion 812-4
references.pmid: 8211698
references.citation: Am J Gastroenterol. 2002 Feb;97(2):249-54
references.pmid: 11866258
references.citation: World J Gastroenterol. 2012 Sep 14;18(34):4639-50
references.pmid: 23002333
references.citation: Br J Surg. 2005 Jan;92(1):76-82
references.pmid: 15521078
references.citation: Br J Surg. 2012 Feb;99(2):160-7
references.pmid: 22183717
references.citation: Hepatobiliary Pancreat Dis Int. 2008 Oct;7(5):520-4
references.pmid: 18842500
references.citation: Gastrointest Endosc. 2006 Feb;63(2):322-3; discussion 323
references.pmid: 16427944
references.citation: Ann Surg. 1942 Jun;115(6):1043-54
references.pmid: 17858034
references.citation: Gastrointest Endosc. 2007 Jul;66(1):52-9
references.pmid: 17324415
references.citation: J Gastrointest Surg. 2008 Jun;12(6):1022-8
references.pmid: 17874273
references.citation: World J Surg. 2008 Oct;32(10):2237-43
references.pmid: 18587614
references.citation: Ann Hepatol. 2014 Sep-Oct;13(5):558-64
references.pmid: 25152990
references.citation: Ann R Coll Surg Engl. 2012 Sep;94(6):375-80
references.pmid: 22943325
references.citation: Hepatogastroenterology. 2010 Jul-Aug;57(101):706-9
references.pmid: 21033214
references.citation: Surg Endosc. 2010 Jan;24(1):33-9
references.pmid: 19466486
references.citation: Gastrointest Endosc. 2008 May;67(6):974-5; discussion 975
references.pmid: 18329028
references.citation: Gastrointest Endosc. 1997 Mar;45(3):277-82
references.pmid: 9087834
references.citation: Arq Bras Cir Dig. 2014 Jul-Sep;27(3):226-7
references.pmid: 25184779
references.citation: Surg Endosc. 2014 Sep;28(9):2690-4
references.pmid: 24737533
references.citation: Int Semin Surg Oncol. 2008 May 21;5:12
references.pmid: 18495037
references.citation: Hepatogastroenterology. 2014 Jul-Aug;61(133):1182-6
references.pmid: 25436279
references.citation: Br J Surg. 1990 Jul;77(7):743-5
references.pmid: 2383747
references.citation: Diagn Ther Endosc. 2011;2011:967017
references.pmid: 21822368
references.citation: Ann Surg. 2012 Jul;256(1):1-6
references.pmid: 22664556
references.citation: Am J Surg. 2008 Jan;195(1):108-14
references.pmid: 18082551
references.citation: Endoscopy. 2006 Jul;38(7):717-22
references.pmid: 16810595
references.citation: Surg Endosc. 2002 Sep;16(9):1363
references.pmid: 12073006
references.citation: HPB (Oxford). 2006;8(6):474-9
references.pmid: 18333104
references.citation: World J Gastroenterol. 2014 Oct 7;20(37):13382-401
references.pmid: 25309071
references.citation: J Gastrointest Surg. 2005 May-Jun;9(5):686-9
references.pmid: 15862264
references.citation: ANZ J Surg. 2006 Sep;76(9):788-91
references.pmid: 16922899
references.citation: Am J Surg. 1995 Jul;170(1):55-9
references.pmid: 7793496
references.citation: Gut. 1996 Jan;38(1):141-7
references.pmid: 8566842
references.citation: Gastrointest Endosc. 1998 Mar;47(3):261-6
references.pmid: 9540880
references.citation: HPB Surg. 1996;9(3):133-6
references.pmid: 8725451
references.citation: Br J Surg. 1989 Nov;76(11):1139-43
references.pmid: 2597969