Management of multicausal iatrogenic bile duct injuries with biliary fistula: Twenty-year experience in a tertiary center

Background and study aims: Biliary surgery is a common procedure, especially cholecystectomy (CCT). Its main adverse event (AE) is biliary duct injury (BDI). Management is poorly codified, particularly for complex BDIs not related to CCT (NONCCT-BDI). We decided to conduct a study in a tertiary center to evaluate clinical outcomes of BDI management. Patients and methods: A single-center retrospective study of patients diagnosed with a BDI between March 2002 and June 2022 was performed. The primary endpoint was the overall success rate for BDI management. Secondary endpoints were outcomes of BDI related to CCT (CCT-BDI) and non-CCT-BDI according to BDI location, need for a combination of procedures, and AEs. Results: Sixty-four patients were included. The overall success rate was 91.8%. Endoscopic retrograde cholangiopancreatography (ERCP) alone was efficient in 97.4% of patients. Endoscopy was key to successful treatment in 69% of patients. Forty-five percent of cases were non-CCT-BDI and the treatment success rate was 88.9%. The treatment success rate was significantly higher for Strasberg A BDIs (P = 0.0337). Conclusions: ERCP remains the best and least invasive treatment for hilar injuries, as evidenced by a high success rate. Management of NON-CCT-BDIs should be modeled after that of CCT-BDIs. Owing to the need for a combination of treatments, complex hilar injuries must be managed in expert centers.