Endoscopic Treatment of Post-Cholecystectomy Biliary Leaks

Abstract

Postcholecystectomy leaks may occur in 0.3–2.7% of patients. Bile leaks associated with laparoscopy are often more complex and difficult to treat than those occurring after open cholecystectomy. Furthermore, their incidence has remained unchanged despite improvements in laparoscopic training and technological developments. The management of biliary leaks has evolved from surgery into a minimally invasive endoscopic procedural approach, namely, endoscopic retrograde cholangiopancreatography (ERCP), which decreases or eliminates the pressure gradient between the bile duct and the duodenum, thus creating a preferential transpapillary bile flow and allowing the leak to seal. For simple leaks, the success rate of endotherapy is remarkably high. However, there are more severe and complex leaks that require multiple endoscopic interventions, and clear strategies for endoscopic treatment have not emerged. Therefore, there is still some debate regarding the optimal time point at which to intervene, which technique to use (sphincterotomy alone or in association with the placement of stents, whether metallic or plastic stents should be used, and, if plastic stents are used, whether they should be single or multiple), how long the stents should remain in place, and when to consider treatment failure. Here, we review the types and classification of postoperative biliary injuries, particularly leaks, as well as the evidence for endoscopic treatment of the latter.

Therapeutic Effect of Laparoscopic Cholecystectomy on Patients with Cholecystolithiasis Complicated with Chronic Cholecystitis and Postoperative Quality of Life

“…Cholecystectomy is the most common procedure in biliary surgery for various acute and chronic cholecystitis, symptomatic gallbladder stones, and gallbladder augmentation lesions, and its long-term outcomes are considered satisfactory in most cases. Cholecystectomy consists of open cholecystectomy and laparoscopic cholecystectomy [14][15][16]. With advances in medical technology, both surgical procedures are effective in the treatment of patients with gallbladder stones combined with chronic cholecystitis, but comparative analyses of their treatment outcomes and postoperative quality of life are inadequate due to the lack of standardized and universally validated tools [17].…”

Surgical treatment of acute cholecystitis in patients with confirmed COVID-19: Ten case reports and review of literature

“…In our series, patients who develop postoperative bile leakage where treated with ERCP. Endoscopic management of biliary leaks (sphincterotomy with or without biliary stent) is associated with more than 90% of biliary leak healing or closure[ 48 ]. ERCP is currently considered the first-line treatment option for biliary leaks, specially cystic stump leaks[ 48 ].…”

“…Endoscopic management of biliary leaks (sphincterotomy with or without biliary stent) is associated with more than 90% of biliary leak healing or closure[ 48 ]. ERCP is currently considered the first-line treatment option for biliary leaks, specially cystic stump leaks[ 48 ]. Surgeons should be aware that when treating patients with difficult cholecystectomies, the goals are to resolve the septic process and to prevent secondary damage.…”

Biliary Fistulas Associated With Liver Transplantation Versus Other Etiologies: What Is the Success Rate of the Endoscopic Treatment?

“…The site of bile leakage must be differentiated according to etiology. Rio-Tinto et al reviewed that, in the case of postcholecystectomy biliary fistulae, Strasberg type A lesions are responsible for up to 85% of all cases (75% of cystic duct stump fistula and 10% of Luschka's duct fistula) 15 . Among the 25 patients, 11 cases of biliary fistula were verified after cholecystectomy; among these 11 patients, 63.6% (7/11) of the fistulae occurred in the cystic duct stump, 27.3% (3/11) in the common hepatic duct, and 9% (1/11) in the common hepatic duct.…”