The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy

espanolIntroduccion: la lesion yatrogenica de la via biliar (LYVB) es una complicacion con elevada morbilidad tras la colecistectomia. En los ultimos anos la endoscopia ha adquirido un papel fundamental en el manejo de esta patologia. Metodos: estudio retrospectivo de LYVB tras colecistectomia abierta (CA) o colecistectomia laparoscopica (CL) tratadas en nuestro centro entre 1993 y 2017. Se analizaron los datos referentes a las caracteristicas clinicas, tipo de lesion segun la clasificacion de Strasberg-Bismuth, diagnostico, tecnica de reparacion y seguimiento. Resultados: se estudian 46 pacientes. La incidencia LYVB fue de 0,48%, 0,61% para las CL y 0,24% para las CA. El diagnostico se realizo de forma intraoperatoria en 12 casos (26%) y mediante colangiopancreatografia retrograda endoscopica (CPRE) en 10 (21,7%). Las caracteristicas mas comunes a todos los pacientes con LYVB fueron la colecistitis aguda (20/46, 43,5%), ingreso previo por patologia biliar (16/46, 43,2%) y realizacion de CPRE previa a la colecistectomia (7/46, 18,9%). Los tipos de LYVB mas frecuentes fueron el D (17/46, 36,9%) y el A (15/46, 32,6%). El tratamiento mas empleado fue sutura primaria (13/46, 28,3%) seguido de CPRE (11/46, 23,9%) con esfinterotomia y/o endoprotesis. Ademas, la CPRE se utilizo en el postoperatorio inmediato de 6 pacientes (13%) con reparacion quirurgica de la LYVB para solucionar complicaciones inmediatas. Conclusion: la CPRE es util en el manejo de la LYVB no diagnosticada intraoperatoriamente. Permite localizar la zona lesionada de la via biliar, realizar maniobras terapeuticas y tratar de manera satisfactoria algunas complicaciones postoperatorias. EnglishIntroduction: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. Methods: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. Results: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. Conclusion: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.