Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

Yachimski, Patrick; Orr, Jordan; Gamboa, Anthony

doi:10.1055/a-1300-1319

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…ERCP can be applied not only in cases of biliary leakage but also for clearance of the biliary tract from residual stones, which can increase the common bile duct pressure and favour leakage from the cystic duct, especially if left open. These two complications were solved using ERCP in 95% of the population [53,54]. Early or late, this procedure can be applied for stenosis of the biliary tract post cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

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Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Toro¹,

Teodoro²,

Khan

et al. 2021

World J Emerg Surg

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Background Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. Patients and methods A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Results Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. Conclusion In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

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Section: Discussionmentioning

confidence: 99%

“…This complication is rarely fatal but requires correct treatment. If bile leakage does not stop spontaneously seven days postoperatively, the possible treatments are endoscopic biliary sphincterotomy [55], endoscopic plastic stent [54], and a fully covered self-expanding metal stent [54].…”

Section: Discussionmentioning

confidence: 99%

Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Toro¹,

Teodoro²,

Khan

et al. 2021

World J Emerg Surg

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“…One of many possible complications of cholecystectomy is bile leakage, and in most studies it was reported to be more frequent during subtotal cholecystectomy (10). Stent placement for bile leak is a treatment option with high success rates (32). However, ERCP is associated to additional costs, time and the possibility of complications such as pancreatitis (3.5%), bleeding (1.3%) and/or perforation (0.6%) (22,33).…”

Section: Bile Leakagementioning

confidence: 99%

State of the art in subtotal cholecystectomy: An overview

2023

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IntroductionSubtotal cholecystectomy is a type of surgical bail-out procedure indicated when facing difficult laparoscopic cholecystectomy due to not reaching the critical view of safety, inadequate identification of the anatomical structures involved and/or risk of injury.Materials and methodsA comprehensive search on PubMed were performed using the following Mesh terms: Subtotal cholecystectomy and Partial cholecystectomy. The PubMed databases were used to search for English-language reports related to Subtotal cholecystectomy between January 1, 1987, the date of the first published laparoscopic cholecystectomy, through January 2023. 41 studies were included.ResultsSubtotal cholecystectomy's incidence oscillates between 4.00% and 9.38%. Strasberg et al., divided subtotal cholecystectomies in “fenestrating” and “reconstituting” types based on if the remaining portion of the gallbladder was left open or closed. Subtotal cholecystectomy can sometimes be a challenging procedure and is associated to a high rate of complications such as biliary fistula, retained gallstones, subhepatic or subphrenic collections, among others.ConslusionSubtotal cholecystectomy is a safe alternative when facing difficult cholecystectomy in which the critical view of safety is not reached in order to avoid complications. A classification system should be implemented in surgical descriptions to compare the different surgical techniques employed. In order to avoid bile leakage and cholecystitis of the remnant gallbladder, the surgical technique must be performed skillfully. There is still a current lack of information on alternative techniques such as omental plugging or falciform patch in order to judge their utility. There needs to be further research on long-term complications such as malignancy of the remnant gallbladder.

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“…Therefore, EST alone is considered an option in minor leaks [6,7]. Biliary stenting using a plastic stent (PS) with or without EST is widely performed, with reported success rates of 53-100% [4,[8][9][10][11][12][13][14][15][16][17]; some cases are refractory and may require additional treatments including percutaneous or surgical interventions [17,18]. ENBD has several advantages such as reliable biliary decompression due cluding percutaneous or surgical interventions [17,18].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Intraductal Placement of a Dumbbell-Shaped Fully Covered Self-Expandable Metal Stent for Post-Cholecystectomy Bile Leaks

Nakagawa,

Matsubara,

Suda

et al. 2023

JCM

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Background and aims: In the treatment of post-cholecystectomy bile leaks, endoscopic naso-biliary drainage (ENBD) or biliary stenting using plastic stents is the standard of care. Fully covered self-expandable metal stent (FCSEMS) placement across the sphincter of Oddi is considered a salvage therapy for refractory cases, but pancreatitis and migration are the major concerns. Intraductal placement of a dumbbell-shaped FCSEMS (D-SEMS) could avoid these drawbacks of FCMSESs. In this retrospective study, we investigated the usefulness of intraductal placement of the D-SEMS for post-cholecystectomy bile leaks. Methods: Six patients who underwent intraductal placement of the D-SEMS for post-cholecystectomy bile leaks were enrolled. This method was performed as initial treatment in three patients and as salvage treatment in three ENBD refractory cases. Results: Technical and clinical successes were obtained in 6 (100%) patients and 5 (83%) patients, respectively. One clinically unsuccessful patient required laparoscopic peritoneal lavage. The early adverse event was one case of mild pancreatitis (17%). The median duration of the D-SEMS indwelling was 61 days (42–606 days) with no migration cases, all of which were successfully removed. The median follow-up after index ERCP was 761 (range: 161–1392) days with no cases of recurrent bile leaks. Conclusions: Intraductal placement of the D-SEMS for post-cholecystectomy bile leaks might be safe and effective even in refractory cases.

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Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

Cited by 6 publications

References 13 publications

Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

State of the art in subtotal cholecystectomy: An overview

Usefulness of Intraductal Placement of a Dumbbell-Shaped Fully Covered Self-Expandable Metal Stent for Post-Cholecystectomy Bile Leaks

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