RIGHT HEPATIC DUCT STENOSIS DUE TO MULTIPLE METALLIC CLIPS AFTER CHOLECYSTECTOMY. IS THERE A WAY OUT? RE-LAPAROSCOPY AND ERCP STENTING
Bile duct lesions with leakage and stenosis can occur after open or laparoscopic cholecystectomy. Multiple factors are involved either related to the patient or external due to technical equipment or surgeon. Bismuth classification is generally accepted. The aim is to restore the bile duct and to prevent short-term and long-term complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis, and secondary biliary cirrhosis. Endoscopic therapy with biliary sphincterotomy alone or with the additional placement of a biliary/nasobiliary stent drainage is recommended. Stenting should be avoided if complete strictures exist or a circumferential resection of the duct. Endotherapy can be considered a sensible option and should be the main-stay treatment in these patients but one must keep in mind it is costly and is usually practiced by experienced teams in tertiary centers. The purpose of our paper is to exemplify this complication which is inherently rare, to highlight the diagnostic and treatment tools with minimal long-term sequelae.
 Diehl AK, Rosenthal M, Hazuda H et al. Socioeconomic status and the prevalence of clinical gallbladder disease. J Chron Dis 1985; 38:1019-1026.
 Lammert F, Neubrand MW, Bittner R et al. S3-guidelines for diagnosis and treatment of gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract. Z Gastroenterol 2007; 45: 971-1001.
 Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290: 2168‑73.
 Lai EC, Lau WY. Mirizzi syndrome: History, present and future development. ANZ J Surg 2006;76: 251‑7.
 Connor S, Garden OJ: Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006; 93: 158– 168.
 Lau WY, Lai EC. Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 2007; 6: 459-63.
 Elhamel A, Nagmuish S, Elfaidi S, Ben Dalal H. Handling of biliary complications following laparoscopic cholecystectomy in the setting of Tripoli Central Hospital. HPB (Oxford) 2002; 4: 105-10.