Utilidad de la colangiopancreatografía retrógrada endoscópica en el diagnóstico y tratamiento de las lesiones yatrogénicas de vía biliar tras colecistectomía
- Marina Garcés Albir 1
- Rosa Martí Fernández 1
- Guillermo Martínez Fernández 1
- Andrés Peña Aldea 2
- E. Muñoz Forner 1
- Vicente Sanchiz Soler 2
- Dimitri Dorcaratto 1
- Consuelo Gálvez Castillo 2
- José Martín Arévalo 1
- Luís Sabater Ortí 1
- Joaquín Ortega Serrano 1
- 1 Instituto de Investigación Biomédica INCLIVA. Valencia
- 2 Hospital Clínico Universitario de Valencia. Valencia.
ISSN: 2340-416, 1130-0108
Year of publication: 2019
Volume: 111
Issue: 9
Pages: 690-695
Type: Article
More publications in: Revista Española de Enfermedades Digestivas
Sustainable development goals
Abstract
Introduction: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. Methods: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. Results: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. Conclusion: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.