Our Summary

In simple terms, this research paper is about the treatment of bile duct injuries, which are serious complications that can occur after liver or gallbladder surgery. These injuries have become more common with the use of a type of surgery called laparoscopic cholecystectomy. They can cause bile leaks or blockages, or both.

Treating these injuries successfully requires a team of specialists, including doctors who use endoscopes (long, flexible tubes with a light and camera at the end) to look inside the body and treat conditions, doctors who use imaging techniques to guide medical procedures, and surgeons who specialize in liver and bile duct surgery.

The main treatment for bile leaks is endoscopic treatment. Depending on the appearance of the bile duct damage, different endoscopic techniques are used, such as draining the bile through the nose, making a cut in the muscle that controls the flow of bile, or placing a prosthesis (artificial device). These techniques can usually stop the leak. In more complex cases, a type of stent (small tube) that can expand by itself and is covered can be used, with high success rates.

The most common endoscopic treatment for bile blockages involves expanding the blocked area with a balloon and placing multiple plastic stents, which are then replaced every three months with an increasing number of stents each time, until the blockage is completely resolved. Metal stents that can expand by themselves have a larger diameter than plastic stents and therefore, a higher rate of keeping the bile duct open. Covered self-expandable stents are another option, with the advantage of being less likely to get blocked and reducing the number of procedures needed.

The purpose of this paper was to review the use of endoscopic treatment in patients with bile duct injuries after liver or gallbladder surgery.

FAQs

  1. What are bile duct injuries and what are their complications?
  2. What kind of team is required for the successful treatment of bile duct injuries?
  3. What are the different endoscopic treatments and techniques for bile duct injuries post-hepatobiliary surgery?

Doctor’s Tip

A doctor may advise a patient undergoing bile duct surgery to follow all post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding heavy lifting or strenuous activities. It is important to communicate any unusual symptoms or concerns to the medical team promptly. Additionally, maintaining a healthy diet and lifestyle can support the healing process and reduce the risk of complications.

Suitable For

Patients who are typically recommended bile duct surgery are those who have suffered bile duct injuries as a complication of hepatobiliary surgery, particularly laparoscopic cholecystectomy. These injuries can present with biliary leak, biliary obstruction, or a combination of both. Endoscopic treatment is the main option for biliary leak, with techniques such as naso-biliary drainage, biliary sphincterotomy, and placement of prostheses being used to achieve leak sealing. For biliary strictures, balloon dilation and placement of multiple plastic or self-expandable metal stents are common treatments, with periodic stent exchanges performed until complete resolution of the stricture is achieved. Covered self-expandable metal stents may also be used for complex biliary fistulas. A multidisciplinary team including biliary endoscopists, interventional radiologists, and hepatobiliary surgeons is typically involved in the management of these patients.

Timeline

Before bile duct surgery:

  1. Patient may experience symptoms such as abdominal pain, jaundice, fever, and nausea.
  2. Diagnostic tests such as ultrasound, CT scan, MRI, and blood tests are performed to determine the extent of the bile duct injury.
  3. Endoscopic retrograde cholangiopancreatography (ERCP) may be performed to visualize the bile ducts and obtain tissue samples for biopsy.
  4. Pre-operative consultations with a multidisciplinary team including biliary endoscopists, interventional radiologists, and hepatobiliary surgeons are conducted.

After bile duct surgery:

  1. Endoscopic treatment is the main option for biliary leak or obstruction.
  2. Depending on the type of biliary damage, various endoscopic techniques such as naso-biliary drainage, biliary sphincterotomy, placement of prosthesis, and covered self-expandable metal stents may be used.
  3. Balloon dilation and placement of multiple plastic or self-expandable metal stents are performed to treat biliary strictures.
  4. Periodic exchange of stents is done every three months until complete resolution of the stricture is achieved.
  5. Covered self-expandable stents may be used to prevent occlusion and reduce the number of required procedures.
  6. Regular follow-up appointments and monitoring are necessary to ensure the success of the endoscopic treatment and to prevent further complications.

What to Ask Your Doctor

  1. What are the potential risks and complications of bile duct surgery?
  2. What is the success rate of the specific procedure being recommended for my bile duct injury?
  3. How long is the recovery period after bile duct surgery?
  4. Will I need any additional treatments or interventions after the surgery?
  5. What is the long-term outlook for my condition after bile duct surgery?
  6. How experienced is the medical team in performing bile duct surgeries?
  7. Are there any alternative treatment options for my bile duct injury?
  8. How can I best prepare for the surgery and optimize my recovery?
  9. Will I need any dietary or lifestyle changes following bile duct surgery?
  10. What follow-up appointments or tests will be necessary after the surgery?

Reference

Authors: Luigiano C, Iabichino G, Mangiavillano B, Eusebi LH, Arena M, Consolo P, Morace C, Fagoonee S, Barabino M, Opocher E, Pellicano R. Journal: Minerva Chir. 2016 Dec;71(6):398-406. Epub 2016 Sep 2. PMID: 27589348