Siiki A, Ahola R, Vaalavuo Y, Antila A, Laukkarinen J. Initial management of suspected biliary injury after laparoscopic cholecystectomy. World J Gastrointest Surg 2023; 15(4): 592-599 [PMID: 37206082 DOI: 10.4240/wjgs.v15.i4.592]
Corresponding Author of This Article
Antti Siiki, MD, PhD, Surgeon, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, Tampere 33521, Finland. antti.siiki@fimnet.fi
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. Apr 27, 2023; 15(4): 592-599 Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.592
Initial management of suspected biliary injury after laparoscopic cholecystectomy
Antti Siiki, Reea Ahola, Yrjö Vaalavuo, Anne Antila, Johanna Laukkarinen
Antti Siiki, Reea Ahola, Yrjö Vaalavuo, Anne Antila, Johanna Laukkarinen, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere 33521, Finland
Johanna Laukkarinen, Faculty of Medicine and Health Technology, University of Tampere, Tampere 33521, Finland
Author contributions: Siiki A, Ahola R, Vaalavuo Y, Antila A and Laukkarinen J contributed to the manuscript drafting and revision.
Conflict-of-interest statement: The authors declare no relevant conflict of interest. Authors Siiki and Laukkarinen have received lecture fees from Boston Scientific, Cook Medical and Olympus Europe.
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: Antti Siiki, MD, PhD, Surgeon, Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Teiskontie 35, Tampere 33521, Finland. antti.siiki@fimnet.fi
Received: December 28, 2022 Peer-review started: December 28, 2022 First decision: January 12, 2023 Revised: January 26, 2023 Accepted: March 15, 2023 Article in press: March 15, 2023 Published online: April 27, 2023
Abstract
Although rare, iatrogenic bile duct injury (BDI) after laparoscopic cholecystectomy may be devastating to the patient. The cornerstones for the initial management of BDI are early recognition, followed by modern imaging and evaluation of injury severity. Tertiary hepato-biliary centre care with a multi-disciplinary approach is crucial. The diagnostics of BDI commences with a multi-phase abdominal computed tomography scan, and when the biloma is drained or a surgical drain is put in place, the diagnosis is set with the help of bile drain output. To visualize the leak site and biliary anatomy, the diagnostics is supplemented with contrast enhanced magnetic resonance imaging. The location and severity of the bile duct lesion and concomitant injuries to the hepatic vascular system are evaluated. Most often, a combination of percutaneous and endoscopic methods is used for control of contamination and bile leak. Generally, the next step is endoscopic retrograde cholangiography (ERC) for downstream control of the bile leak. ERC with insertion of a stent is the treatment of choice in most mild bile leaks. The surgical option of re-operation and its timing should be discussed in cases where an endoscopic and percutaneous approach is not sufficient. The patient's failure to recover properly in the first days after laparoscopic cholecystectomy should immediately raise suspicion of BDI and this merits immediate investigation. Early consultation and referral to a dedicated hepato-biliary unit are essential for the best outcome.
Core Tip: A rare, but potentially disastrous bile duct injury (BDI) after laparoscopic cholecystectomy may easily go unnoticed at first. Thus, any unwell patient or anyone not recovering properly in the first post-operative days after surgery should be considered as having a surgical complication unless proven otherwise. The right initial management in suspected BDI is essential for prognosis. Early referral to a hepato-biliary unit, combination of modern imaging modalities and consequent evaluation of the severity grade of the injury are the foundations of management. The initial treatment options range from percutaneous and endoscopic methods to surgery, the timing and details of which need a multi-disciplinary hepato-biliary approach.
