How effective is endoscopic stenting in management of post-cholecystectomy bile duct injuries – experience of a tertiary care hepatobiliary center in a developing country

Abstract

Iatrogenic bile duct injury(IBDI) is the most serious complication of cholecystectomy. Endoscopic stenting is an alternative to surgery in managing IBDI and data on this aspect is scarce in our setting. Post cholecystectomy ERCPs(suspecting IBDI) were analysed and categorized into Bismuth-Strasberg classification(A-E). E(1–5) were considered as major injuries. The stented patients were evaluated for symptom improvement, need of repeat endoscopy and complications. Eighty seven IBDI was detected during ERCP(2007–2016, 70% following Laparoscopic cholecystectomy). Male:female was 1:3 and mean age was 38.6 years(range 28–70). 53% had minor injuries(Bismuth-Strasburg A-D). Cystic stump leak was the commonest single injury(36%). All the minor injuries(n = 46) were stented with 7Fr or 10 Fr plastic stents. All stented patients needed repeat ERCP(two monthly in most cases) with a median number of 5(range 2–11) and 81% underwent serial dilatation and multiple stenting. All the patients had symptom improvement within three months of the initial intervention. In stented group 5 patients(10%) needed surgery as they developed chronic CBD stricture which were not improved with at least 6 attempts of serial dilatation(after 3 years of initial surgery). Zero mortality was reported in stented group. Minor IBDI can be effectively managed with ERCP and stenting according to our data. Serial dilatation with repeated ERCP is needed in most of the cases but avoiding a major surgery would be an advantage. The number of serial dilations attempts before deciding on reconstructive surgery should be evaluated further as many patients improved after multiple attempts of dilatation.