Biodegradable Biliary Stents: A New Approach for the Management of Hepaticojejunostomy Strictures Following Bile Duct Injury. Prospective Study

Abstract

Background:Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods:In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results:In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion:The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

The Critical View of Safety Prevents the Appearance of Biliary Injuries? Analysis of a Survey

“…Our results also found, as mentioned in previous reports, that IOC was not associated with lower reports of BDI 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 . However, unlike other authors that have suggested that IOC is becoming an endangered technique 6 , over 90% of respondents to the survey admitted to performing IOC at some point, therefore it seems that reports promoting the benefits of it 2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24 continue to promote IOC as a risk-reducing technique and might explain why it seems to still be very alive among surgeons in the area.…”

“…However, despite its application, BDI rates have not decreased even in centers where it is routinely used 14 , 19 ; this phenomenon has been analyzed in several studies 15 , 20 , 21 , 22 , 23 . The use of CVS, however, is associated with lower BDI rates 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , therefore the possibility of incorrect application of CVS should be identified promptly if there is hope to benefit from its application.…”

“…Iaparoscopic cholecystectomy (LC) is the gold standard for management of gallstones 1 1 . However, the risk of bile duct injury (BDI) remains a significant concern 10 , as LC continues to have a higher BDI rate than its open counterpart, despite many efforts proposed for increasing safety 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 .…”

Manejo percutáneo y endoscópico combinado de las estenosis benignas de la vía biliar

“…Sin embargo, numerosos estudios 4,5,11,14,19 han comunicado resultados con el tratamiento endoscópico comparables a la cirugía con menor morbimortalidad. En ausencia de estudios controlados que comparen la cirugía con las alternativas no quirúrgicas, los datos actuales sugieren que la inserción endoscópica secuencial de múltiples prótesis puede alcanzar un elevado porcentaje de éxitos terapéuticos a largo plazo 4,5,11,18,19. El beneficio del tratamiento percutáneo se estima en las mejores series 4,10,19 en torno al 60-90%, con una tasa de complicaciones del 33%, de tipo hemorrágico o séptico. Al igual que en el abordaje endoscópico, por vía percutánea se aplica el mismo concepto de realizar una o múltiples dilataciones sostenidas con la introducción de varias prótesis 4,5,9,10 .…”

Surgical management for bile duct injury

“…For BDI detected soon after surgery, such as injury without local inflammation can be performed with primary repair (38). In cases with abdominal infection, biliary peritonitis, vascular injury, or other complicated conditions, delayed repair should be performed after the measures of controlling bile leakage and infection and improving the patient's general condition (39,40). Although the early idea holds that the timing of delayed repair should be at least 3 months away from the injury, current evidence suggests that definitive repair surgery may be performed 4-6 weeks after local inflammation and infection are effectively controlled (41,42).…”