A Study on Endoscopic Management of Postcholecystectomy Bile Duct Injuries

Aim: To study postcholecystectomy bile duct injuries (BDIs) and their endoscopic management

Methods: Patients referred for suspected postcholecystectomy BDI from January 2023 to January 2023 were included . All patients underwent Magnetic resonance cholangio-pancreaticography (MRCP) before planning the definitive management.

26 patients were included in the study. In patients with simple biliary leak, sphincterotomy with or without stenting was done and followed up at 4 to 6 weeks for stent removal. In patients with biliary stricture and preserved ductal continuity, serial dilation with Sohendra dilator and plastic stenting of incremental size and number was done and were followed up at 3 months. Sessions were repeated at 3 month intervals till complete resolution of stricture is noted on cholangiogram.

Figure 1

Results: 15/26 (57.6%) underwent laparoscopic cholecystectomy.

11/26 underwent open cholecystectomy.

19/26 (73%) patients presented with bile leak.

9/19(47.3%) had cystic duct stump leak.

4/19 (21%) had leak from RHD/LHD, 3/19 (15.7%) had leak from CHD. Cholangiogram could not reveal the leak in 3/19 (15.7%). Inadvertent CBD clip application was noted in 3 patients and were referred for surgical management. Success rate for biliary leak management was 18/19 (94.7%). In patients with bile duct stricture 7/26 (26.9%), 4 patients had CHD and 3 patients had CBD stricture. Endoscopic Sohendra dilation and stenting was successful in 5/7 (71.4%) patients.

A median of 4 sessions were required (2–6) for stricture resolution. 2/26 patients were sent for surgical management

Conclusion: ERCP with stent placement is effective for management of bile leaks and strictures and should be considered as a first line modality for management of BDIs

Publication History

Article published online:
22 April 2024