Non-surgical treatment of post-surgical bile duct injury: Clinical implications and outcomes

Abstract

Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI.

Long-Term Patency of Metallic Stents in a Patient with Bile Duct Injury Refractory to Long-Term Catheter Placement Following Right Hepatectomy for Liver Metastasis

“…Catheter stenting is the first-line treatment, and subsequent diversion of the fistula by endoscopic or percutaneous transhepatic techniques is necessary in addition to drainage of the biloma cavity [1][2][3][4][5][6]. Intrahepatic diversion of the biliary system decreases the intrabiliary pressure by rerouting the flow of bile away from the defect in the bile duct.…”

“…Sandha et al [5] reported that temporary biliary stenting for 4 to 6 weeks yielded satisfactory results in more than 90% of 207 consecutive patients with severe bile leaks or strictures. However, bile duct injuries, especially bile leaks concomitant with biliary strictures, that cannot be definitively treated with percutaneous or endoscopic techniques require surgical repair [3][4][5].…”

“…Temporary placement of a plastic stent is also effective for severe leaks or strictures [5,6]. However, such a strategy fails to yield satisfactory results in some cases [3][4][5]. Here, we present a case of bile duct injury after right hepatectomy that could not be healed by PTBD catheter placement, but was successfully repaired after three sessions of metallic stent placement.…”

“…Most bile leaks can be managed solely with percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD) to properly direct the bile duct flow and allow the problem to resolve [1][2][3][4]. Temporary placement of a plastic stent is also effective for severe leaks or strictures [5,6].…”

Surgical management for bile duct injury

“…For BDI detected soon after surgery, such as injury without local inflammation can be performed with primary repair (38). In cases with abdominal infection, biliary peritonitis, vascular injury, or other complicated conditions, delayed repair should be performed after the measures of controlling bile leakage and infection and improving the patient's general condition (39,40). Although the early idea holds that the timing of delayed repair should be at least 3 months away from the injury, current evidence suggests that definitive repair surgery may be performed 4-6 weeks after local inflammation and infection are effectively controlled (41,42).…”