A modification of rendezvous technique for endoscopically treating transected common bile duct following cholecystectomy

Abstract

Endoscopic therapy is the standard of care for management of most benign biliary strictures. However, endoscopic therapy can fail in very tight strictures. We report a case of a 52-year-old lady who had complete bile duct transection with stricture after laparoscopic cholecystectomy. In initial attempt, at endoscopic retrograde cholangiopancreatography (ERCP), guidewire could not be negotiated endoscopically across the narrowing as there was complete cut off of the bile duct and so a percutaneous transhepatic biliary drainage (PTBD) was done and subsequently internalized into the duodenum. We cannulated the internalized end of PTBD catheter with the standard ERCP cannula with guidewire and advanced it across the biliary stricture. PTBD catheter was withdrawn externally, and the guidewire was left in the left ductal system. We report this innovation as this may be helpful in managing patients with ERCP after an initial PTBD has been successfully internalized into the duodenum.

Creation of Neo-Bile Duct in Patients with Hepatic Duct Injury or Transection during Laparoscopic/Robotic Cholecystectomy

“…Sharma et. al, displayed a 52-year-old female statuspost LC due to symptomatic gallstone disease who was able to successfully undergo a rendezvous procedure with biliary stenting after complete transection of the CBD allowing for improvement in biliary drainage [6]. Iatrogenic injury of the bile duct or hepatic ducts during surgery can have severe consequences, and the creation of a neo-bile duct rendezvous procedure has emerged as a valuable technique to address complex BDIs, offering improved outcomes and reduced morbidity and mortality.In summary, we present a case series with severe BDI after LC.…”