Kalayarasan R, Sai Krishna P. Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives. World J Gastrointest Surg 2023; 15(10): 2098-2107 [PMID: 37969703 DOI: 10.4240/wjgs.v15.i10.2098]
Corresponding Author of This Article
Raja Kalayarasan, FRCS (Ed), MBBS, MCh, MS, Additional Professor, Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri nagar, Puducherry 605006, India. kalayarasanraja@yahoo.com
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2098-2107 Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2098
Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives
Raja Kalayarasan, Pothugunta Sai Krishna
Raja Kalayarasan, Pothugunta Sai Krishna, Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India
Author contributions: Kalayarasan R and Sai Krishna P did the literature search; Sai Krishna P wrote the first draft of the review; Kalayarasan R conceptualized the work, supervised the writing, gave intellectual inputs, and critically revised the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raja Kalayarasan, FRCS (Ed), MBBS, MCh, MS, Additional Professor, Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri nagar, Puducherry 605006, India. kalayarasanraja@yahoo.com
Received: May 30, 2023 Peer-review started: May 30, 2023 First decision: July 18, 2023 Revised: August 1, 2023 Accepted: August 17, 2023 Article in press: August 17, 2023 Published online: October 27, 2023 Processing time: 149 Days and 16.1 Hours
Abstract
Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.
Core Tip: Minimally invasive postcholecystectomy biliary stricture repair is an attractive and controversial option to manage this iatrogenic injury with serious health and litigation consequences. Recent evidence suggests a potential role of minimally invasive approaches especially robotic surgery. Refinements in minimally invasive techniques can widen the scope of minimally invasive surgery. Future studies should overcome the current evidence's limitations and help choose the most suitable method for repair in a patient with bile duct injury.
