Endoscopic treatment of aberrant right posterior hepatic duct injuries: single-center results

Injuries to an aberrant right posterior hepatic duct (ARPHD) are rare but clinically significant complications of cholecystectomy, often resulting in bile leakage and strictures. This study aims to contribute to the limited literature by presenting our findings on the role and effectiveness of endoscopic treatment of ARPHD injuries.

Patients underwent endoscopic treatment for post-cholecystectomy ARPHD injury in a tertiary center between 2008 and 2024 included retrospectively. In addition to standard wire-guided cannulation, rendezvous methods or magnetic compression anastomosis methods were employed. Patient demographics, type of injuries (Strasberg classification), biliary anatomy, endoscopic treatment strategies, and clinical outcomes were analyzed.

A total of 28 patients (53.6% female, mean age 49 years) with ARPHD injuries underwent endoscopic treatment. Strasberg type C was observed in 20 (71.4%) patients, type E5 in 7 (25.0%), and type B in 1 (3.6%). ARPHD cannulation was successful in 90.0% of type C and 85.7% of type E5 cases. All successfully cannulated type C patients achieved leak resolution. Strictures developed in 11 of type C patients after leak resolution and were treated endoscopically. In all type E5 patients, the existing common bile duct and ARPHD strictures were successfully managed endoscopically. In the single type B case, bile duct continuity was restored by magnetic compression anastomosis technique. After a median follow-up of 47 months (range: 3-136), stent-free follow-up was achieved in 75.0% (21/28) of patients after a mean of 4.6 ± 1.2 endoscopic sessions. Three patients, in whom the ARPHD could not be cannulated, required surgery.

Although technically challenging, endoscopic management of ARPHD injuries offers high success in treating bile leaks and strictures, making it a reliable alternative to surgery in most cases.