Experiencia del manejo por colangiopancreatografía retrógrada endoscópica de las fístulas biliares poscolecistectomía en un hospital de referencia en Colombia / Experience in endoscopic retrograde cholangiopancreatography management of postcholecystectomy biliary leak in a Colombian referral hospital

Resumen Introducción: la fistula biliar poscolecistectomía es poco frecuente. El manejo principalmente es endoscópico, pero en la literatura no hay consenso en la técnica de primera línea entre papilotomía, prótesis biliar o su combinación. Metodología: se realizó un estudio observacional tipo serie de casos en el que se incluyeron todas las CPRE realizadas en el Hospital Universitario San Ignacio en Bogotá, Colombia, entre enero de 2010 y marzo del 2021 por fistula biliar posterior a colecistectomía. Se registraron las características demográficas, manifestaciones clínicas, resolución, eventos adversos y estancia hospitalaria según la técnica endoscópica. Resultados: se incluyeron 24 pacientes con fistula biliar poscolecistectomía que se manejaron con CPRE. La mediana de edad fue de 59 años (rango intercuartílico [RIC]: 53,5-67). En el 75% el tipo de cirugía fue laparoscópica. La manifestación clínica más frecuente fue aumento del drenaje biliar > 150 mL/24 horas (50%), seguido de dolor abdominal (39%). La principal localización fue el conducto cístico en el 40%. El manejo con papilotomía fue del 25%; con prótesis biliar, 8,4%, y combinado, 66%; la resolución de la fístula ocurrió en el 100%, 50% y 87%, respectivamente, con menor estancia hospitalaria en el manejo combinado de 3,5 días frente a 4 días en papilotomía. Solo se presentó 1 evento adverso de hemorragia en el grupo de papilotomía. Conclusión: la papilotomía y la terapia combinada son opciones terapéuticas con buenas tasas de resolución y baja estancia hospitalaria para el manejo de las fistulas biliares poscolecistectomía. Se requerirán estudios prospectivos, aleatorizados y multicéntricos para definir la técnica con mejores desenlaces clínicos.

Abstract Introduction: Postcholecystectomy biliary leak is rare. Management is mainly endoscopic, but in the literature, there is no consensus on the first-line technique between sphincterotomy, biliary stent, or combination. Materials and methods: A case series study was conducted that included all ERCP performed at the San Ignacio University Hospital in Bogotá, Colombia, between January 2010 and March 2021 due to biliary leak after cholecystectomy. Demographic characteristics, clinical manifestations, resolution, adverse events, and hospital length stay were recorded according to the endoscopic technique. Results: 24 patients with postcholecystectomy biliary leak managed with ERCP were included. The median age was 59 years (interquartile range [IQR]: 53.5-67). In 75% the surgery was laparoscopic. The most frequent clinical manifestation was increased biliary drainage > 150 mL/24 hours (50%), followed by abdominal pain (39%). The main fistula's location was the cystic duct in 40%. Management with sphincterotomy was 25%, with a biliary stent, 8.4%, and combined, 66%; leak resolution occurred in 100%, 50%, and 87%, respectively, with a shorter hospital length stay in the combined management of 3.5 days compared to four days in sphincterotomy. Only one adverse bleeding event occurred in the sphincterotomy group. Conclusion: Sphincterotomy and combined therapy are options with reasonable resolution rates and low hospital length stay for managing postcholecystectomy biliary leak. Prospective, randomized, and multicenter trials will be required to define the best technique.

Posttraumatic biloma formation: diagnosis and management

One of the rarest complications of the hepatic trauma is a biloma, defined as an abnormal bile collection outside the biliary tree, with intra or extrahepatic localization. Patients with biloma do not present with specific clinical features, which demands a challenging radiological diagnosis. In this report, we present a case of biloma due to blunt hepatic trauma, in which the patient experienced a changing symptomatic spectrum after surgery and had an interesting radiological investigation. The clinical course, imaging features, and management of this case are discussed. (AU)

The value of laparoscope in the treatment of biliary leak after laparoscopic cholecystectomy / 中国微创外科杂志

Objective To explore the value of laparoscope in the treatment of biliary leak after laparoscopic cholecystectomy (LC). Methods 16 cases of biliary leak after LC from August 1996 to May 2001 were reviewed retrospectively. Results 14 patients with biliary leak without bile duct injury were operated on under laparoscope. 2 patients with biliary leak and bile duct injury were converted to open operation. Conclusions Laparoscope can confirm reasons of biliary leak and shorten hospitalization time of patients with biliary leak without bile duct injury.