Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Abstract

Bile leaks remain a signifi cant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration with laparoscopy and ligation of the injured subvesical duct should be considered. We present herein the case of a 31-year-old woman with refractory bile leakage from a disrupted subvesical duct after cholecystectomy that could not be managed with endoscopic sphincterotomy and plastic-stent placement. A newly designed, fully covered, self-expandable metal stent (FC-SEMS) was successfully placed for the treatment of refractory bile leaks in this patient. It appears that temporary placement of an FC-SEMS is technically feasible and provides an effective alternative to surgical therapy for refractory bile leaks after cholecystectomy. (Gut Liver 2011;5:96-99)

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

“…In our series, the bile output from the percutaneous drains ceased after a median time of 3 days (range 2-8 days) following FCSEMS placement. This result is comparable to earlier studies [3,19,28], suggesting that stents could be removed earlier than previously reported (for both partially and fully covered SEMS). In our study, stents were removed after a median time of 16 days, which deviated from earlier studies [20,25].…”

“…The FCSEMS remained in place for 36 days, despite the fact that external drainage stopped 24 h after insertion. In a recent case report [28], a patient with a Luschka's duct leak treated with an FCSEMS after unsuccessful endoscopic management with ES and plastic stent placement had the stent removed after 28 days. Again, the authors reported an almost immediate decrease in the bile output from the percutaneous drain.…”

Functional Self-Expandable Metal Stents in Biliary Obstruction

“…3, 4). 22-24 Results of such studies were not always positive, however, because the attached antireflux valve often caused malfunction depending on its design. Antireflux valve designed to minimize the risk of malfunction led to decreased resistance for antireflux function, while that designed for greater resistance interfered with bile drainage, working against the original purpose of stent insertion.…”

Aberrant subvesical bile ducts identified during laparoscopic cholecystectomy: A rare case report and review of the literature

“…More specifically, injury of a subvesical bile duct is quietly inevitable [1] and it is one of the most common etiologies of bile leakage in cholecystectomies [3] , [12] , [13] . In fact, approximately 27% of clinically significant bile leaks are occurred by injury to a subvesical bile duct [1] .…”