[Surgery and interventional techniques in biliary tract diseases. Combined procedure or concurrent procedure?]

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Interventional Endoscopy
• Surgical Oncology

Context:

• Bile duct stones, benign lesions, and malignant stenoses present complex diagnostic and therapeutic challenges.
• Optimal management necessitates an interdisciplinary approach, often involving surgical and interventional specialists.
• Treatment decisions are frequently guided by limited data, leading to varied therapeutic strategies.

Purpose:

• To review current interdisciplinary approaches for managing bile duct stones, benign lesions, and malignant stenoses.
• To delineate indications for surgical versus interventional treatments.
• To compare the efficacy of different therapeutic modalities.

Summary:

• Cholelithiasis with common bile duct stones (cholecystocholedocholithiasis) is best managed by endoscopic stone extraction combined with laparoscopic cholecystectomy.
• Laparoscopic common bile duct exploration offers a potential future advantage.
• Emergency interventions are crucial for purulent cholangitis and biliary pancreatitis.
• Transpapillary or transhepatic prostheses are suitable for bile duct injuries and short strictures.
• Surgical repair is indicated for extensive strictures or defects.
• Malignant stenoses benefit most from surgical treatment for survival, with interventional palliation for unresectable cases.
• Stent and prosthesis outcomes are comparable.

Impact:

• Provides a framework for optimizing patient care pathways in hepatobiliary diseases.
• Highlights the evolving role of minimally invasive techniques in bile duct management.
• Informs clinical decision-making for complex bile duct pathologies.