Endoscopic Management of Bile Duct Injury During Laparoscopic Cholecystectomy

With the advent of laparoscopic cholecystectomy the incidence of iatrogenic lesions of the biliary tree have raised to up to three times. In the past, surgical repair was the treatment of choice of bile duct injuries, while today endoscopic retrograde cholangio-pancreatography is the first-line treatment for the majority of these injuries. Early bile duct injuries present within 1 week from surgery, and represent about 10 % of all post-cholecystectomy injuries. The vast majority of bile duct injuries become symptomatic after weeks or months after surgery, when the injury has evolved into a stricture. Endoscopic management of bile duct injuries varies on the basis of the type of injury, the presence or not of biliary leakage and/or bile duct stones, and the time of onset, whereas management of strictures is mostly dependent on their complexity. At present, sole biliary sphincterotomy with or without stones extraction and/or stent placement is the treatment of choice for the majority of bile leaks. The treatment of choice for bile duct strictures is plastic multistenting with every 3-month stent exchange during a period of 1 year.