Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks

Marks, Jeffrey M.; Ponsky, Jeffrey L.; Shillingstad, R. B.; Singh, Jagdeep

doi:10.1007/s004649900663

Cited by 100 publications

(60 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Newer techniques of ante-grade biliary stenting have been described. [14][15][16] During LECBD, either trans-cystic or choledochotomy, a biliary stent is inserted to facilitate drainage. These stents require endoscopic removal.…”

Section: Discussionmentioning

confidence: 99%

Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile Duct

Jameel

Darmas

Baker

2008

annals

View full text Add to dashboard Cite

INTRODUCTION The aim of this study was the assessment of patient outcome, peri-operative complications, length of stay and duration of operation after laparoscopic primary closure of the common bile duct (CBD) compared with choledochotomy with T-tube drainage and trans-cystic exploration. PATIENTS AND METHODS Analysis of prospectively collected data on 71 explorations of the common bile duct between July 2001 and March 2006. RESULTS A total of 71 patients had exploration of the CBD. Within this group, 12 were referred after failed endoscopic retrograde cholangiopancreatography (ERCP). The methods of exploration included trans-cystic (9 cases), choledochotomy with Ttube (12), and choledochotomy with primary closure (50). CBD stones were found in 66 patients. In the remaining cases, we found a stricture in 1, debris in 2, and dilatation of the CBD without a stone in 2. There were 5 conversions to open technique and 3 patients required postoperative ERCP (1 with permanent stenting). Peri-operative complications included T-tube (3), primary closure group (9), and trans-cystic (0). There was no statistical significant difference (Chi-square test, P = 0.296) between the groups. There was a trend towards a shorter length of stay in the primary closure group as compared with the trans-cystic and T-tube groups of 4.16, 4.44, and 6.33 days, respectively. However, it did not reach statistical significance (one-way analysis of variance with Boneferroni correction, mean difference between groups 1.89, 0.28, 2,17, statistical significance at P < 0.05). The shortest operating time was in the primary closure group (95.92 min) which was statistically significant (P < 0.001). We did not use a biliary drain in the last 48 patients. CONCLUSIONS Primary laparoscopic closure of the CBD is safe and results in a reduction in operating time. Choledochoscopy ensures clearance of the CBD and eliminates the need for T-tube.

show abstract

Section: Discussionmentioning

confidence: 99%

Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile Duct

Jameel

Darmas

Baker

2008

annals

View full text Add to dashboard Cite

show abstract

“…The mean time of closure was significantly shorter in the biliary stent group compared to the endoscopic sphincterotomy group among patients with a distal common bile duct diameter ≤ to 8 mm. Furthermore, in a canine model of cystic duct leak, biliary stenting significantly reduced the time to resolution of leaks compared to sphincterotomy, supporting the use of biliary stenting as a primary treatment of biliary leaks [8].…”

mentioning

confidence: 79%

“…Finally, there was no direct comparison between endoscopic sphincterotomy and biliary stent placement alone without sphincterotomy. The use of stent placement alone without sphincterotomy, with its inherent risks, is a central question that has been posed several times in the literature for which several studies have confirmed its effectiveness [5][6][7][8].…”

mentioning

confidence: 99%

Endoscopic Treatment of Biliary Leaks After Laparoscopic Cholecystectomy: Cut or Plug?

Brady

Taunk

2017

Dig Dis Sci

View full text Add to dashboard Cite

“…The presence of bilomas is suggested by the progressive growth of a well-circumscribed, low attenuation intraparenchymal or perihepatic fluid collections on cross-sectional imaging studies [54]. The majority of patients with suspected bilomas are currently treated by the placement of percutaneous drainages under radiological guidance while ERCP with the insertion of biliary stenting is indicated for those patients with expanding or persistent bilomas that failed resolution after external drainage [53,55].…”

Section: Bilomasmentioning

confidence: 99%

Traumatic Bile Duct Injuries

Molinari¹

2016

Actual Problems of Emergency Abdominal Surgery

View full text Add to dashboard Cite

The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree. Accidental traumas are responsible only for 1-5% of the total number of biliary injuries. The diagnosis of non-iatrogenic traumatic bile duct injuries is challenging as current cross-sectional imaging tests are not very specific. Therefore, most of the patients are diagnosed when they undergo early explorative laparotomy or when they develop late complications. Among all patients who experience traumatic bile duct injuries, 80-90% are victims of penetrating traumas from stab or gunshot wounds. On the other hand, bile duct lesions due to blunt traumas are predominantly caused by traffic accidents (compression by safety belt or airbag), falls, kicks, or work accidents. Iatrogenic bile duct injuries have been extensively covered in many other papers. In this chapter, we will focus our attention only on traumatic bile duct injuries.

show abstract

Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks

Abstract: Biliary stenting significantly reduces the time to resolution of cystic duct leaks as compared to sphincterotomy in a canine model. The results obtained in this study support the use of biliary endoprostheses in the management of biliary leaks and fistulae.

Cited by 100 publications

References 30 publications

Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile Duct

Trend towards Primary Closure Following Laparoscopic Exploration of the Common Bile Duct

Endoscopic Treatment of Biliary Leaks After Laparoscopic Cholecystectomy: Cut or Plug?

Traumatic Bile Duct Injuries

Contact Info

Product

Resources

About