Year 2019 / Volume 111 / Number 9
Original
The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy

690-695

DOI: 10.17235/reed.2019.6245/2019

Marina Garcés-Albir, Rosa Martí-Fernández, Guillermo Martínez-Fernández, Andrés Peña-Aldea, Elena Muñoz-Forner, Vicente Sanchiz-Soler, Dimitri Dorcaratto, Consuelo Gálvez-Castillo, José Martín-Arévalo, Luis Sabater, Joaquín Ortega,

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: 46 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 10 (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 6 (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.
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Garcés-Albir M, Martí-Fernández R, Martínez-Fernández G, Peña-Aldea A, Muñoz-Forner E, Sanchiz-Soler V, et all. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. 6245/2019


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Publication history

Received: 20/02/2019

Accepted: 15/03/2019

Online First: 01/08/2019

Published: 05/09/2019

Article revision time: 15 days

Article Online First time: 162 days

Article editing time: 197 days


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