Transhepatic metallic stenting for hepaticojejunostomy stricture following laparoscopic cholecystectomy biliary injury: A case of successful 20 years follow-up

Abstract

Laparoscopic cholecystectomy is still associated with a considerable rate of biliary injuries and related strictures. Advances in interventional endoscopy and percutaneous techniques have made stenting a preferred treatment modality for the management of these strictures. We report successful 20 years of follow-up of a case of trans-hepatic metallic stenting (2 Gianturco(®) prostheses, 5 cm long, 2 cm in diameter) done for stenosed hepatico-jejunostomy anastomosis after laparoscopic CBD injury. Percutaneous transhepatic stenting and long-term placement of metallic stents need to be re-evaluated as a minimally invasive definitive treatment option for benign biliary strictures in patients with altered anatomy such as hepatico-jejunostomy or in whom re-operation involves high risk.

Keywords: Biliary SEMS; hepatico-jejunostomy stricture; iatrogenic bile duct injuries; metallic biliary stents; percutaneous transhepatic biliary stenting; postoperative biliary strictures.

Figure 1

Percutaneous transhepatic cholangiography (dye injection in left duct) at the time of stent deployment: Two 5 cm transhepatic Gianturco^® prostheses placed through the right ducts across the anastomosis. The lower prosthesis is fully open; the upper, located in normal size duct, is partially open

Figure 2

Recent CT scan and 3D reconstruction of the liver and biliary tree in virtual imaging [using VR-Render™, WeBSurg Limited Edition (WLE) - IRCAD Image Viewer Software (http://www.websurg.com/softwares/vr-render/)]. The prostheses (white arrow) are still well positioned. Left and right hepatic ducts are not dilated