Endoscopic sphincterotomy in the management of postoperative biliary fistula

Abstract

Endoscopic sphincterotomy is safe and effective and should be considered the minimally invasive procedure of choice for the management of postoperative biliary fistula due to HHD because it obviates the need for reoperation. If the sphincterotomy is successful, neither the daily output not the duration of the fistula has any influence on the time required for complete closure of the fistula.

Endoscopic stenting for selected cases of biliary fistula after hepatic hydatid surgery

“…Our experience also suggests that ES is safe and effective for management of biliary complications of hepatic hydatid disease. In the literature, closure time of postoperative fistulas after ERCP-ES was reported to range from 3 days to 43 days [7,9,19,20,24]. Rodriguez et al have had successful results with ES in 8 patients, where postoperative fistula and external drainage ceased within 15-43 days of operation (mean 25 days) [16].…”

“…Through this connection, hydatid material may enter into the biliary tree or bile may leak into the cyst. In cases where there is communication between the biliary tract and the residual cyst cavity, bile may flow from the biliary tree into the cystic cavity as a result of the pressure gradient formed after surgery [7]. This can also be aggravated by stenosis of the sphincter of Oddi or occlusion of the CBD with the hydatid material.…”

“…Some endoscopists prefer nasobiliary drainage because it reduces biliary tree pressure and allows contrast visualization of the biliary tract and cavity. However; patient discomfort, prolongation of the hospitalization, and the probability of displacement of the tip of the drainage tube are all disadvantages of this method [7,19].…”

Management of Giant Hydatid Liver Disease: A Case Report and Review of Literature

“…Although there are reports stating that all the biliary fistulas close spontaneously after surgical treatment of liver HD, they persist in 4%-27.5% of cases (28,29). Endoscopic sphincterotomy has been proposed in biliary fistula of more than 3 weeks' duration or with output exceeding 300 ml/day but unfortunately these reports come from adult series (4,30).…”

Epidemiology, clinical manifestations and diagnosis of zoonotic cestode infections: an update

“…This is also true for the intrabiliary rupture and persistent biliary leakage after surgery for hepatic CE. In such cases, the endoscopic retrograde cholangiopancreatography (ERCP) is valuable for detecting and treating postoperative complications after surgery for hepatic CE (Cucinotta et al 2002;Dolay et al 2002;Bilsel et al 2003). Using ERCP, patients with biliary fistulas and daughter cysts in the bile ducts can be managed by endoscopic sphincterotomy (ES) and evacuation of the obstructing cyst material.…”