Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes.
Endoscopy
; 50(6): 577-587, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29351705
ABSTRACT
BACKGROUND:
Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure.METHODS:
All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed.RESULTS:
Among a total of 812 patients, rendezvous was performed in 47 (6â%), 31 (66â%) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94â% (44â/47 patients). Overall morbidity was 18â% (10â/55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23â-â54 months), rendezvous was the final successful treatment in 26â/47 patients (55â%). In 14â/47 patients (30â%), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis.CONCLUSIONS:
In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55â%. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ductos Biliares
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Colangiopancreatografia Retrógrada Endoscópica
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Colecistectomia Laparoscópica
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Ducto Hepático Comum
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Jejuno
Tipo de estudo:
Etiology_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article