Endoscopic management of post-operative biliary tract injuries

Abstract

Post-operative biliary tract injuries have traditionally been treated by surgery; since the 1990s, however, this was replaced by endoscopic methods. These complications occur most frequently after laparoscopic surgery. Whenever biliary leakage is suspected, a close cooperation between endoscopists and surgeons is essential. Immediate visualisation of the biliary tract by endoscopic retrograde cholangio-pancreatography (ERCP) is mandatory to confi rm the diagnosis and locate the exact site of the lesion. Various endoscopic techniques have proven to be effective in the treatment of post-cholecystectomy biliary leaks. The crucial point is to equalise duodenal and biliary tract pressures so that bile fl ow into the duodenum is ensured and healing of the lesion is facilitated. This can be achieved by endoscopic sphincterotomy either alone or in combination with subsequent implantation of a plastic stent. These methods seem to be equally suitable; for greater lesions, however, insertion of a stent is advisable. For biliary tract strictures, multiple stenting is recommended, the results of which are promising in the long run as well.