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Rev Esp Enferm Dig. 2019 Aug 1;111. doi: 10.17235/reed.2019.6245/2019. [Epub ahead of print]

The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy.

Author information

1
Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, España.
2
Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia.
3
Cirugía General, Hospital Clínico Universitario de Valencia, España.
4
Departamento de Cirugía, Hospital Clínico. Universidad de Valencia., Española.
5
Cirugía General y del Aparato Digestiv, Hospital Clínico Universitario de Valencia. Universidad de Valencia, España.

Abstract

INTRODUCTION:

Iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology.

METHODS:

a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed.

RESULTS:

forty-six patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in ten (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in six (13%) patients with a surgical IBDI repair in order to resolve immediate complications.

CONCLUSION:

ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.

PMID:
31368333
DOI:
10.17235/reed.2019.6245/2019
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