Comparison of sphincterotomy alone versus sphincterotomy and biliary stent placement for the treatment of post-laparoscopic cholecystectomy biliary leaks

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt.

Abstract

Background: While a number of endoscopic procedures have demonstrated efficacy in the management of post-cholecystectomy biliary leakage (PCBL), the optimal treatment is still up for debate. Endoscopic biliary stenting (BS) with or without endoscopic sphincterotomy (ES), nasobiliary tube drainage with or without ES, and endoscopic sphincterotomy alone (ES) are among the endoscopic procedures that have been employed.
Aim: Our research aims to assess the safety and effectiveness of biliary stenting in addition to endoscopic sphincterotomy vs sphincterotomy alone for the management of biliary leakage following laparoscopic cholecystectomy.
Patients and methods: The study comprised 50 patients in total, divided into two groups of 25 patients each, who had been diagnosed with post-laparoscopic cholecystectomy biliary leakage. Of them, 25 had endoscopic sphincterotomy alone, and 25 underwent endoscopic sphincterotomy plus the implantation of a biliary stent. The effectiveness of each patient's therapy was then monitored clinically.
Results: There were six cases among the group I patients where ES alone was ineffective; four underwent surgical treatment, and two were successfully treated with stent implantation thereafter. Out of the 25 group II patients, only 2 cases (8%), required surgery to repair the leak following ERCP. For groups I and II, the total complication rate was 8% and 16%, respectively.
Conclusion: While the ES alone group had a reduced risk of adverse events, biliary stent + ES is more efficacious than ES alone for the treatment of post-laparoscopic cholecystectomy biliary leakage. As a result, the preferred method for endoscopic therapy of PCBL should be ERCP with stent implantation plus ES, even if it necessitates a further endoscopic procedure to remove the biliary stent.

Keywords

The Egyptian Journal of Surgery
Volume 44, Issue 1
January 2025
Pages 231-237

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