Rendezvous per il management delle lesioni alla VBP post-colecistectomia

Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes. Schreuder AM, Booij KAC, de Reuver PR, van Delden OM, van Lienden KP, Besselink MG, Busch OR, Gouma DJ,Rauws EAJ, van Gulik TM. Endoscopy. 2018 Jan 19. [Epub ahead of print]

BACKGROUND:Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity.

The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure.METHODS:All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed.RESULTS:Among a total of 812 patients, rendezvous was performed in 47 (6%), 31 (66%) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94% (44/47 patients). Overall morbidity was 18% (10/55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23-54 months), rendezvous was the final successful treatment in 26/47 patients (55%). In 14/47 patients (30%), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis.CONCLUSIONS:In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55%. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery.

leggi l'articolo

Informazioni aggiuntive