Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes
submitted 24. Juli 2017
accepted after revision 13. November 2017
19. Januar 2018 (online)
Background Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure.
Methods All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed.
Results Among a total of 812 patients, rendezvous was performed in 47 (6 %), 31 (66 %) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94 % (44 /47 patients). Overall morbidity was 18 % (10 /55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23 – 54 months), rendezvous was the final successful treatment in 26 /47 patients (55 %). In 14 /47 patients (30 %), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis.
Conclusions In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55 %. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery.
- 1 Calvete J, Sabater L, Camps B. et al. Bile duct injury during laparoscopic cholecystectomy: myth or reality of the learning curve?. Surg Endosc 2000; 14: 608-611
- 2 Go PM, Schol F, Gouma DJ. Laparoscopic cholecystectomy in The Netherlands. Br J Surg 1993; 80: 1180-1183
- 3 Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg 2016; 40: 73-80
- 4 Booij KA, de Reuver PR, Yap K. et al. Morbidity and mortality after minor bile duct injury following laparoscopic cholecystectomy. Endoscopy 2015; 47: 40-46
- 5 Strasberg SM, Gouma DJ. ‘Extreme’ vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders. HPB (Oxford) 2012; 14: 1-8
- 6 Booij KAC, de Reuver PR, van Dieren S. et al. Long-term impact of bile duct injury on morbidity, mortality, quality of life, and work related limitations. Ann Surg 2017; DOI: 10.1097/SLA.0000000000002258.
- 7 de Reuver PR, Rauws EA, Bruno MJ. et al. Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery 2007; 142: 1-9
- 8 Flum DR, Cheadle A, Prela C. et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003; 290: 2168-2173
- 9 de Reuver PR, Rauws EA, Vermeulen M. et al. Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success. Gut 2007; 56: 1599-1605
- 10 Janssen JJ, van Delden OM, van Lienden KP. et al. Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Cardiovasc Intervent Radiol 2014; 37: 1559-1567
- 11 Rauws EA, Gouma DJ. Endoscopic and surgical management of bile duct injury after laparoscopic cholecystectomy. Best Pract Res Clin Gastroenterol 2004; 18: 829-846
- 12 de Reuver PR, Grossmann I, Busch OR. et al. Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg 2007; 245: 763-770
- 13 Dominguez-Rosado I, Sanford DE, Liu J. et al. Timing of surgical repair after bile duct injury impacts postoperative complications but not anastomotic patency. Ann Surg 2016; 264: 544-553
- 14 Stilling NM, Fristrup C, Wettergren A. et al. Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study. HPB (Oxford) 2015; 17: 394-400
- 15 Ismael HN, Cox S, Cooper A. et al. The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford) 2017; 19: 352-358
- 16 Donatelli G, Vergeau BM, Derhy S. et al. Combined endoscopic and radiologic approach for complex bile duct injuries (with video). Gastrointest Endosc 2014; 79: 855-864
- 17 Fiocca F, Salvatori FM, Fanelli F. et al. Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvous. Gastrointest Endosc 2011; 74: 1393-1398
- 18 Tomizawa Y, Di Giorgio J, Santos E. et al. Combined interventional radiology followed by endoscopic therapy as a single procedure for patients with failed initial endoscopic biliary access. Dig Dis Sci 2014; 59: 451-458
- 19 Calvo MM, Bujanda L, Heras I. et al. The rendezvous technique for the treatment of choledocholithiasis. Gastrointest Endosc 2001; 54: 511-513
- 20 Bergman JJ, van den Brink GR, Rauws EA. et al. Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut 1996; 38: 141-147
- 21 Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001; 25: 1241-1244
- 22 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180: 101-125
- 23 Slankamenac K, Graf R, Barkun J. et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013; 258: 1-7
- 24 Parlak E, Disibeyaz S, Odemis B. et al. Endoscopic treatment of patients with bile duct stricture after cholecystectomy: factors predicting recurrence in the long term. Dig Dis Sci 2015; 60: 1778-1786
- 25 Meduri B, Derhy S, Dhumane P. et al. Extra-anatomical intraduodenal endoscopic-radiologic biliary rendezvous for treatment of iatrogenic complete stenosis of the common bile duct. Endoscopy 2015; 47: E565-566
- 26 Perez-Miranda M, Aleman N, de la Serna Higuera C. et al. Magnetic compression anastomosis through EUS-guided choledochoduodenostomy to repair a disconnected bile duct in orthotopic liver transplantation. Gastrointest Endosc 2014; 80: 520-521
- 27 Tomoda T, Kato H, Mizukawa S. et al. Biliary anastomotic stricture after adult living donor liver transplantation with duct-to-duct reconstruction: outcome after endoscopic treatment including rendezvous procedure. Transplantation 2016; 100: 1500-1506
- 28 Iwashita T, Yasuda I, Mukai T. et al. EUS-guided rendezvous for difficult biliary cannulation using a standardized algorithm: a multicenter prospective pilot study (with videos). Gastrointest Endosc 2016; 83: 394-400
- 29 Kawakubo K, Kuwatani M, Kato S. et al. Direct puncture of the ampulla as a modified endoscopic ultrasound-guided rendezvous technique. Endosc Ultrasound 2017; DOI: 10.4103/eus.eus_31_17.
- 30 Nakai Y, Isayama H, Matsubara S. et al. A novel “hitch-and-ride” deep biliary cannulation method during rendezvous endoscopic ultrasound-guided ERCP technique. Endoscopy 2017; 49: 983-988
- 31 Sommer A, Burlefinger R, Bayerdorffer E. et al. [Internal biliary drainage in the “rendezvous” procedure. Combined transhepatic endoscopic retrograde methods]. Dtsch Med Wochenschr 1987; 112: 747-751
- 32 Benner KG, Ivancev K, Porayko MK. et al. Re-establishment of biliary tract continuity by a combined ERCP and PTC approach after iatrogenic common bile duct ligation. Gastrointest Endosc 1992; 38: 506-509
- 33 Nasr JY, Hashash JG, Orons P. et al. Rendezvous procedure for the treatment of bile leaks and injury following segmental hepatectomy. Dig Liver Dis 2013; 45: 433-436
- 34 Curcio G, Miraglia R, Ligresti D. et al. Intraperitoneal rendezvous: a mini-invasive biliary reconstruction. Gastrointest Endosc 2016; 84: 184-185
- 35 Gronroos JM. Unsuccessful endoscopic stenting in iatrogenic bile duct injury: remember rendezvous procedure. Surg Laparosc Endosc Percutan Tech 2007; 17: 186-189
- 36 Miller T, Singhal S, Neese P. et al. Non-operative repair of a transected bile duct using an endoscopic-radiological rendezvous procedure. J Dig Dis 2013; 14: 509-511
- 37 Odemis B, Oztas E, Akpinar MY. et al. An alternative treatment for biliary injuries characterized by complete transection of the common bile duct: intraperitoneal rendezvous. Therap Adv Gastroenterol 2017; 10: 521-523
- 38 Rana S, Sharma V, Arun AC. et al. A modification of rendezvous technique for endoscopically treating transected common bile duct following cholecystectomy. J Dig Endosc 2014; 5: 129
- 39 Stewart L, Robinson TN, Lee CM. et al. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg 2004; 8: 523-531
- 40 de Reuver PR, Sprangers MA, Rauws EA. et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment. Endoscopy 2008; 40: 637-643