This paper was presented at the Annual General Scientific and Fellowship Meeting of the Royal Australasian College of Surgeons, 10–12 September 2010, Melbourne, Victoria.
Endoscopic management of post-cholecystectomy biliary fistula
Article first published online: 19 JUL 2011
© 2011 International Hepato-Pancreato-Biliary Association
Volume 13, Issue 10, pages 699–705, October 2011
How to Cite
Hii, M. W., Gyorki, D. E., Sakata, K., Cade, R. J. and Banting, S. W. (2011), Endoscopic management of post-cholecystectomy biliary fistula. HPB, 13: 699–705. doi: 10.1111/j.1477-2574.2011.00353.x
- Issue published online: 19 SEP 2011
- Article first published online: 19 JUL 2011
- Received 11 April 2011; accepted 30 May 2011
- bile duct injury;
- biliary fistula
Objective: Bile duct injury is an uncommon but potentially serious complication in cholecystectomy. A recognized treatment for minor biliary injury is internal biliary decompression by endoscopic retrograde cholangiopancreatography (ERCP) and stent insertion. The aim of this study was to assess the effectiveness of ERCP in the management of minor biliary injuries.
Methods: A retrospective review of medical records at a tertiary referral centre identified 36 patients treated for postoperative minor biliary injuries between 2006 and 2010. Management involved establishing a controlled biliary fistula followed by ERCP to confirm the nature of the injury and decompress the bile duct with stent insertion.
Results: Controlled biliary fistulae were established in all 36 patients. Resolution of the bile leak was achieved prior to ERCP in seven patients, and ERCP with stent insertion was successful in 27 of the remaining 29 patients. Resolution of the bile leak was achieved in all patients without further intervention. The median time to resolution after successful ERCP was 4 days. Two patients underwent ERCP complicated by mild pancreatitis. No other complications were seen.
Conclusions: This review confirms that postoperative minor biliary injuries can be managed by sepsis control and semi-urgent endoscopic biliary decompression.