Treatment of Common Bile Duct Injuries After Surgery

Classification

There are multiple classifications, of which the Strasberg classification remains the most widespread and widely used. Strasberg classifies the biliary tract injuries according to anatomic considerations and therapeutic alternatives. The authors recommend Strasberg because it identifies potential endoscopically treatable lesions and also because it is widely accepted by surgical teams (Fig. 1).¹

There are no management algorithms based on evidence that allow determination of which lesions of the

Biliary fistula

Small biliary fistulas are common after cholecystectomy. If postoperative ultrasonography was performed routinely, small fluid collections would be detected in the gallbladder bed in 24% of patients. Most of these resolve spontaneously, without requiring any procedure.⁸ By contrast, approximately 0.8% to 1.1% of patients had significant postoperative biliary fistulas that were suspected as being due to persistent biliary drainage through the T-tube or drainage tubes, or symptoms of pain and

Stenosis of biliary duct

Benign strictures of the biliary tree remain a challenge. Although important technological development has led to improved diagnostic and therapeutic methodology, the high morbidity and mortality associated with this entity represent a serious clinical problem.

The objective in the management of biliary strictures is to relieve obstruction, and prevent restenosis and secondary hepatocellular damage. Duct injuries are recognized intraoperatively in about 25% of patients, and many can be repaired

Special considerations for liver transplantation

Biliary complications after orthotopic liver transplantation (OLT) are present in up 20% of patients, of which the most common are stricture, bile leaks, stones, and dysfunction of the sphincter of Oddi. In this article only strictures and bile leaks are discussed.

The clinical presentation of post–liver transplant bile duct complications is often subtle, and the only clue for the diagnosis is commonly an asymptomatic increase in the baseline serum transaminase or bilirubin levels.

The use of

Summary

The treatment of common biliary duct injuries after surgery remains a challenge for physicians. This article reviews some endoscopic therapeutic options in the management of biliary injuries after surgery, including liver transplantation.

At present, the indications and contraindications for endoscopic management are based primarily on recommendations from experts. The management of biliary tract injuries will depend on the nature and extent of the injury, the presence or absence of biloma, and