Endoscopic management of postoperative biliary injuries

Abstract

The postoperative complications of the biliary tract, such as leakages and strictures, traditionally had been managed surgically, but from the 90s they are usually treated via endoscopic route. These complications occur most frequently after laparoscopic surgeries. Whenever biliary leakage is suspected, close collaboration between endoscopists and surgeons is needed. Immediate visualization of the biliary tract by ERCP is mandatory to confirm the diagnosis and to locate the exact site of the lesion. Various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks. The crucial point is to equalize the duodenal and the biliary pressures, allowing flow of the bile into the duodenum, advancing the healing of the lesion. This can be achieved with a simple endoscopic sphincterotomy or endoscopic sphincterotomy with subsequent insertion of a plastic stent. These methods seem to be equally suitable; however, for greater lesions stent placement is advisable. For strictures multiple stenting is the effective method, and the long standing effects also seem to be good.