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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
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[Endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy]
1Divisione di Gastroenterologia, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria.
Background:
To evaluate the role of the endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy.
Methods:
From January 1993 to December 1997, 16 patients with biliary fistulas after laparoscopic cholecystectomy have been treated. All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic sphincterotomy (ES) and 12 biliary endoprosthesis were inserted, left in seat for 4-6 weeks, and a nasal-biliary drain, removed after 4 days.
Results:
The seat of the leak was cystic duct in 12 cases, common hepatic duct in 2 cases and an intrahepatic duct in 2 cases. Eleven patients showed common bile duct stones, treated by endoscopic extraction, and two patients showed a biliary ascites, previously drained percutaneously. In all the patients a fast regression of the clinical signs and of the biohumoral index were observed, and at the time of stent removal the leak was always absent.
Conclusions:
The results obtained confirm the primary role of ERCP in the management of biliary duct injuries, as a definitive diagnosis and an immediate treatment, often resolutive, is guaranteed.
