Introduction
Management of poscholecystectomy complications has been variably discussed. Various options exist but the recent trend has been towards the endoscopic retrograde approach favoring a simultaneous diagnostic and therapeutic potential.
Aims & Methods
Objetive: A single institution retrospective analysis of 203 with bile duct injuries (BDI) after laparoscopic cholecystectomy (LC). We studied the various endoscopic modalities to evaluate the efficacy of the approach.
Patients and Methods: From January 2005 to January 2025, a retrospective analysis was conducted of 5528 patients referred to the endoscopy department. During this period, 434 were referred after related BDI. These 434 (7,8%) are BDI. 231(53,2%) after open cholecystectomy and 203 (46,8%) after LC, formed the basis for this study. 154 (75,8%) were female and 49 (24,2%) were male, with an average age of 49,1years (range,13-88 years). The clinical presentation of the BDI: jaundice 134 (66,0%); pain 47 (23,1%); fever 79 (38,9%); persistent drainage 75 (36,9%); pruritus 74 (36,4%) and acute biliary pancreatitis 18 (8,8%). ERCP was used in all cases.
Results
There were 103 patients with stricture (26 total transaction and 77 partial) and 64 (31,6%) patients with leaks and 36 (17,7%) had a combination of leaks and stricture. Endoscopic diagnosis was feasible in all cases. Subsequently, 170 (83, 7% ) patients were considered for endotherapy and endoscopic treatment was interrupted in 17 patients, required surgical intervention, success healing was shown in 90% There 64 biliary fistulae: 40 of the cystic stump, 20 of the common hepatic and 2 of the right hepatic and 2 of the left hepatic; 36 (17,7%) biliary fistulae with stenosis (9 complete transaction and 27 partial transaction) and 103 stenosis (26 total transaction and 77 partial). The 35 total transaction required surgical treatment; however two were treated by endoscopies. There was success in the endoscopic treatment of biliary fistulae, which 64 esphincterotomy transpapilar (ETP) and four stents. 27 patients with biliary fistulae with stenosis were 6 ETP; 11 ETP with stents; 8 ETP, dilatation, stents and two ETP with dilatation and two patients need the surgical treatment. 71/77 (92,2%) patients with stenosis could be treated: 34 ETP, stents; 36 ETP, dilatation, stents; and 3 ETP, dilatation. Complications occurred in 6 (3, 5%), perforation (n = 1), mild pancreatites (n=3), and cholangitis (n=2) and 17 patients failed endoscopic treatment.
Conclusion
The ERCP in biliary complications of LC is feasible and with good results. It firms as coadjuvant treatment of the definitive surgery and in some situations being the method close for the definitive treatment.
Disclosure
No Conflict of Interest