Ricerc@Sapienza

Introduction: Complete transection of the common bile duct is a dramatic complication after biliary surgery especially after laparoscopic cholecystectomy. Since
1995 we have proposed an endoscopic – radiologic rendez-vous that successfully
obtains the reconstruction of the biliary tree in a minimal invasive way. After
treatment with 4 or 5 biliary plastic stents left in place for at least one year1
patients were followed up for at least five years.
Aims and Methods: Since 1995, 91 patients were treated for complete transection
of the common bile duct: 3 patients had traumatic biliary section, 88 iatrogenic,
(73 after lap.chole. 15 after open surgery).
All patients were successfully treated with endoscopic-radiologic rendez-vous and
after right and left transhepatic approach 4 or 5 plastic 10 F stents were radiologically put in place. After 12 months, the stents were endoscopically removed
and a control cholangiography with an ERCP was performed. If stones and
sludge were found they were removed. In case of duct stenosis a new transhepatic
approach was made and several plastic stents put in place again for 12 months.
The patients were followed up for 5 years with blood analysis, ultrasounds and
MR cholangiography.
Results: 60 patients were evaluated as 21 were lost at follow-up and 10 are under
treatment, 44 patients (73%) are well after 5 years without any symptoms of
cholestasis and biliary dilatation at MR cholangiography. 2 patients died for
sepsis after 6 and 12 months of treatment. 4 patients had cholangitis after 6
and 8 months: the stents were removed and replaced after recovery, 16 patients
had stenosis of the main bile duct after stent removal: they were treated again
with 4 plastic stents for 1 year, 8 patients had stenosis recurrence during follow
up after 2 or 3 years: they were treated endoscopically and a fully covered selfexpanding metallic stent left in place for one year. All patients, also those
retreated, are well after 5 years of follow up.
Conclusion: The radiologic-endoscopic rendez-vous is a safe and efficient technic
for minimal invasive treatment of the common bile duct complete section. It is
challenging for the radiologist as the intrahepatic biliary ducts are thin and for
the endoscopist that has to puncture the duct often clipped. It requires many
sessions for complete treatment and in a few cases treatment for stenosis recurrence but in this way we can avoid surgical treatment on the biliary tree that
requires difficult intervention which has a high morbidity and mortality.
Disclosure: Nothing to disclose