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CC BY 4.0 · Endosc Int Open
DOI: 10.1055/a-2788-3182
Original article

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

Authors

  • Victor Garbay 

    1   Gastroenterology, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Jean-Philippe Ratone

    1   Gastroenterology, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Cristophe Zemmour

    2   Statistics, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Solene Hoibian

    3   Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Yanis Dahel

    4   Endoscopy Unit, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Anais Palen

    5   Digestive Surgery Unit, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Jonathan Garnier

    5   Digestive Surgery Unit, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Jacques Ewald

    6   Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Olivier Turrini

    6   Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Marc Giovannini

    7   UEMCO, Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)

  • Caillol Fabrice

    6   Institut Paoli-Calmettes, Marseille, France (Ringgold ID: RIN56181)
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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.



Publication History

Received: 24 February 2025

Accepted after revision: 13 January 2026

Accepted Manuscript online:
30 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Victor Garbay, Jean-Philippe Ratone, Cristophe Zemmour, Solene Hoibian, Yanis Dahel, Anais Palen, Jonathan Garnier, Jacques Ewald, Olivier Turrini, Marc Giovannini, Caillol Fabrice. Management of multicausal iatrogenic bile duct injuries with biliary fistula: Twenty-year experience in a tertiary center. Endosc Int Open ; 0: a27883182.
DOI: 10.1055/a-2788-3182