Endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy

BACKGROUND: To evaluate the role of the endoscopic treatment of biliary fistulas after laparoscopic cholecystectomy. METHODS: From January 1993 to December 1997, 16 patients with biliary fistulas after laparoscopic cholecystectomy have been treated. All patients underwent endoscopic retrograde cholangio-pancreatography (ERCP) and endoscopic sphincterotomy (ES) and 12 biliary endoprosthesis were inserted, left in seat for 4-6 weeks, and a nasal-biliary drain, removed after 4 days. RESULTS: The seat of the leak was cystic duct in 12 cases, common hepatic duct in 2 cases and an intrahepatic duct in 2 cases. Eleven patients showed common bile duct stones, treated by endoscopic extraction, and two patients showed a biliary ascites, previously drained percutaneously. In all the patients a fast regression of the clinical signs and of the biohumoral index were observed, and at the time of stent removal the leak was always absent. CONCLUSIONS: The results obtained confirm the primary role of ERCP in the management of biliary duct injuries, as a definitive diagnosis and an immediate treatment, often resolutive, is guaranteed.