Endoscopic nasobiliary drainage for bile duct injury after laparoscopic cholecystectomy

Abstract

Bile duct injuries are a potential complication of laparoscopic cholecystectomy (LC). A patient who underwent successful endoscopic nasobiliary drainage (ENBD) for a bile duct injury sustained during LC is presented. Of particular note, the patient also had Chilaiditi's syndrome. A 59-year-old woman was admitted with symptomatic cholecystolithiasis and Chilaiditi's syndrome. LC was performed. Postoperatively, the patient complained of abdominal discomfort. Laboratory examination revealed cholestasis. Bilious material began spilling from an intraabdominal drain. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) showed bile leakage. ENBD was performed. Repeat ERCP 10 days later failed to show a bile leak or stenosis of the common bile duct. The patient improved rapidly and had no complaints after the procedure. ENBD is a useful endoscopic technique to prevent peritonitis from bile leakage after LC. Chilaiditi's syndrome is not a contraindication for LC.

A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak

“…Although accessory bile ducts of Luschka (also called supravesicular ducts) do not drain any liver parenchyma, they can be a source of bile leak or biliary peritonitis after cholecystectomy [25]. Less common are the leaks from damage to the CBD or proximal hepatic ducts [10,[12][13][14][15][16][17][18][19]. Therapy for bile leak includes percutaneous drainage of fluid collections (bilomas), therapeutic ERCP, and surgery.…”

“…The objective of endoscopic intervention is to abolish the pressure gradient across the sphincter of Oddi, thereby promoting preferential bile flow into the duodenum and allowing the leak to heal [26]. This can be successfully achieved by a diversity of techniques, including biliary sphincterotomy, stent insertion (with or without sphincterotomy), or nasobiliary tube drainage alone [10,[12][13][14][15][16][17][18][19]. Treatment success has ranged from 85% to 100% in most studies, with very low complication rates reported for all endoscopic treatment modalities [10,[12][13][14][15][16][17][18][19][20].…”

“…The majority of bile leaks can be managed by one or more of the following techniques: stent placement, nasobiliary drainage, or sphincterotomy [12][13][14][15][16][17][18][19]. Many endoscopists prefer to place a stent with its proximal end above the level of the leak aiming to seal off the offending area, although similar results can be achieved with a short stent stranding the papilla.…”

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

“…The incidence of BDI during LC is higher than that in open cholecystectomy [8,14,18,36,43], in which rates less than 0.25% have mostly been reported (range, 0.1-0.6%) [4,15,29,40]. Therefore, improvement of safety standards in LC depends strictly on the decrease of biliary tract injuries.…”

Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy

“…Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques [7], laparoscopic management of these injuries is poor. In this clinical study, we investigated the efficacy of laparoscopic management of the bile duct and bowel injuries during laparoscopic cholecystectomy.…”