Utilidad de la colangiopancreatografía retrógrada endoscópica en el diagnóstico y tratamiento de las lesiones yatrogénicas de vía biliar tras colecistectomía / The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy

Introducción: la lesión yatrogénica de la vía biliar (LYVB) es una complicación con elevada morbilidad tras la colecistectomía. En los últimos años la endoscopia ha adquirido un papel fundamental en el manejo de esta patología. Métodos: estudio retrospectivo de LYVB tras colecistectomía abierta (CA) o colecistectomía laparoscópica (CL) tratadas en nuestro centro entre 1993 y 2017. Se analizaron los datos referentes a las características clínicas, tipo de lesión según la clasificación de Strasberg-Bismuth, diagnóstico, técnica de reparación y seguimiento. Resultados: se estudian 46 pacientes. La incidencia LYVB fue de 0,48%, 0,61% para las CL y 0,24% para las CA. El diagnóstico se realizó de forma intraoperatoria en 12 casos (26%) y mediante colangiopancreatografía retrógrada endoscópica (CPRE) en 10 (21,7%). Las características más comunes a todos los pacientes con LYVB fueron la colecistitis aguda (20/46, 43,5%), ingreso previo por patología biliar (16/46, 43,2%) y realización de CPRE previa a la colecistectomía (7/46, 18,9%). Los tipos de LYVB más frecuentes fueron el D (17/46, 36,9%) y el A (15/46, 32,6%). El tratamiento más empleado fue sutura primaria (13/46, 28,3%) seguido de CPRE (11/46, 23,9%) con esfinterotomía y/o endoprótesis. Además, la CPRE se utilizó en el postoperatorio inmediato de 6 pacientes (13%) con reparación quirúrgica de la LYVB para solucionar complicaciones inmediatas. Conclusión: la CPRE es útil en el manejo de la LYVB no diagnosticada intraoperatoriamente. Permite localizar la zona lesionada de la vía biliar, realizar maniobras terapéuticas y tratar de manera satisfactoria algunas complicaciones postoperatorias

Introduction: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. Methods: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. Results: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. Conclusion: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications

The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy.

INTRODUCTION: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. METHODS: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. RESULTS: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. CONCLUSION: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.