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Minerva Chirurgica 2016 Dicembre;71(6):398-406

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Endoscopic management of bile duct injury after hepatobiliary tract surgery: a comprehensive review

Carmelo LUIGIANO 1, Giuseppe IABICHINO 1, Benedetto MANGIAVILLANO 2, Leonardo Henry EUSEBI 3, Monica ARENA 1, Pierluigi CONSOLO 4, Carmela MORACE 4, Sharmila FAGOONEE 5, Matteo BARABINO 6, Enrico OPOCHER 6, Rinaldo PELLICANO 7

1 Unit of Digestive Endoscopy, San Paolo Hospital, Milan, Italy; 2 Unit of Gastroenterology and Digestive Endoscopy, General Hospital of Sanremo, Sanremo, Italy; 3 Unit of Gastroenterology, S. Orsola-Malpighi University Hospital, Bologna, Italy; 4 Department of Medicine and Pharmacology, University of Messina, Hospital “G. Martino”, Messina, Italy; 5 Institute for Biostructures and Bioimages CNR c/o Molecular Biotechnology Center, University of Turin, Turin, Italy; 6 Department of Surgery, Unit of Hepatobilyopancreatic and Digestive Surgery, San Paolo Hospital, University of Milan, Milan, Italy; 7 Department of Gastro-Hepatology, Molinette Hospital, Turin, Italy

Bile duct injuries (BDIs) are the most serious complications after hepatobiliary surgery and are associated with high morbidity and mortality. The incidence of iatrogenic injuries of bile ducts has increased after the advent of laparoscopic cholecystectomy. BDIs present with biliary leak or biliary obstruction or a combination of both. Successful treatment of these complications requires a multidisciplinary team that includes biliary endoscopists, interventional radiologists and hepatobiliary surgeons. Endoscopic treatment is the main option for biliary leak. Depending on colangiographic appearance of the biliary damage, several endoscopic techniques (naso-biliary drainage, biliary sphincterotomy, placement of prosthesis) are used, allowing to achieve the leak sealing in most cases. In complex biliary fistulas the use of covered self-expandable metal stents is another therapeutic option with high success rates. The most common endoscopic therapy for biliary strictures involves balloon dilation and placement of multiple plastic stents followed by the periodic exchange of the stents. This is usually performed every three months by placing an increasing number of stents each time, until complete resolution of the stricture. Self-expandable metal stents have a larger diameter compared to plastic stents and therefore, higher patency rate. Covered self-expandable stents are an alternative option with the advantage of providing better permeability, preventing occlusion, and reducing the number of the required procedures. The aim of this paper was to review the endoscopic management of patients with bile duct injuries after hepatobiliary surgery.

lingua: Inglese


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