Preliminary Report of Percutaneous Cholecystostomy As Diagnosis and Treatment of Biliary Tract Trauma

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2018 Jun 9

PMID 29882101

Citations 2

Authors

Jean-Baptiste Cazauran

Arnaud Muller

Baptiste Hengy

Pierre-Jean Valette

Laurent Gruner

Olivier Monneuse

Affiliations

Soon will be listed here.

Abstract

Background: Biliary leak following severe blunt liver injuries is a complex problem becoming more frequent with improvements in non-operative management. Standard treatment requires main bile duct drainage usually performed by endoscopic sphincterotomy and stent placement. We report our experience with cholecystostomy as a first minimally invasive diagnostic and therapeutic approach.

Methods: We performed a retrospective analysis of consecutive patients with post-traumatic biliary leak between 2006 and 2015. In the first period (2006-2010), biliary fistula was managed using perihepatic drainage and endoscopic, percutaneous or surgical main bile duct drainage. After 2010, cholecystostomy as an initial minimally invasive approach was performed.

Results: Of 341 patients with blunt liver injury, 18 had a post-traumatic biliary leak. Ten patients received standard treatment and eight patients underwent cholecystostomy. The cholecystostomy (62.5%) and the standard treatment (80%) groups presented similar success rates as the first biliary drainage procedure (p = 0.41). Cholecystostomy presented no severe complications and resulted, when successful, in a bile flow rate inversion between the perihepatic drains and the gallbladder drain within a median [IQR] 4 days [1-7]. The median time for bile leak resolution was 26 days in the cholecystostomy group and 39 days in the standard treatment group (p = 0.09). No significant difference was found considering median duration of hospital stay (54 and 74 days, respectively, p = 0.37) or resuscitation stay (17.5 and 19.5 days, p = 0.59).

Conclusion: Cholecystostomy in non-operative management of biliary fistula after blunt liver injury could be an effective, simple and safe first-line procedure in the diagnostic and therapeutic approach of post-traumatic biliary tract injuries.

Citing Articles

Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma.

Brunese M, Avella P, Cappuccio M, Spiezia S, Pacella G, Bianco P J Pers Med. 2024; 14(6).

PMID: 38929793 PMC: 11204538. DOI: 10.3390/jpm14060572.

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines.

Coccolini F, Kobayashi L, Kluger Y, Moore E, Ansaloni L, Biffl W World J Emerg Surg. 2019; 14:56.

PMID: 31867050 PMC: 6907251. DOI: 10.1186/s13017-019-0278-6.

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