Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):199-204. 10.14701/ahbps.24-186.

Post-cholecystectomy total bile duct strictures: Cases for magnetic compression anastomosis

• Graterol FP
• Marcano FS
• Barrios YV
• Rivero-Moreno Y
• Lee DK

• KMID: 2568269
• DOI: http://doi.org/10.14701/ahbps.24-186

Abstract

Bile duct injuries are a serious issue, and their surgical treatment carries the risk of morbidity and mortality. In selected cases, non-surgical treatments are possible, even for total strictures. We outline the technique and results of using magnetic compression anastomosis (MCA) to treat post-cholecystectomy bile duct stricture (PCBDS), in two female patients. Initially, a bilio-cutaneous tract was established via external biliary drainage, followed by the positioning of both endoscopic and percutaneous biliary magnets. After their approximation and subsequent removal, a fully covered self-expandable metal stent (FCSEMS) was deployed across the stricture. The magnet coupling was successfully achieved within the first two weeks of placement. The FCSEMS was maintained for durations of 12 and 16 months. Follow-up durations were 28 and 15 months post-FCSEMS removal. Both patients remain asymptomatic, with normal laboratory and imaging studies, and no adverse events were reported. MCA proves to be a safe and effective method for treating selected cases of total PCBDS. However, further studies and long-term follow-up are required to fully assess the efficacy of this technique.

Keyword

Biliary tract; Bile ducts; Stricture; Magnetics

Figure

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  Fig. 1 Strasberg´s classification for bile duct injuries. Type A: bile leak from cystic duct stump or small biliary ducts in the gallbladder bed, type B: clipping or occlusion of aberrant right hepatic duct(s), type C: bile leak from right posterior sectoral duct injuries, type D: bile leak from a lateral injury of the common hepatic duct (CHD), type E (Bismuth classification): injury of CHD. Depending on the stricture level, below the confluence of hepatic ducts: E1: > 2 cm, E2: < 2 cm, E3: preserved hepatic ducts confluence, E4: injury at the biliary confluence or above, separating the right and left hepatic ducts, E5: injury of the CHD + an aberrant right hepatic duct.

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  Fig. 2 Samarium and Cobalt magnets (4 mm × 8 mm) (Taewoong Medical®).

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  Fig. 3 Strasberg type E2 biliary stricture. Magnetic resonance cholangiopancreatography reveals a 5-mm gap between the ends of the main bile duct (A). There is no contrast passage through the stricture during endoscopic (B) and percutaneous cholangiography (C).

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  Fig. 4 Sequence of percutaneous and endoscopic insertion of biliary magnets. Dilating the percutaneous biliary tract (A), the proximal magnet is anchored to a 16 Fr silicone feeding tube (B); subsequent fluoroscopic guidance allows pushing the magnet until it reaches the proximal biliary end (C). The endoscopic magnet is then advanced (D) until both magnets are aligned as closely as possible (E).

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  Fig. 5 Magnet coupling (A, B), biliary recanalization (C), and placement of a fully covered self-expandable metal stent (D).

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  Fig. 6 Percutaneous-endoscopic cholangiogram (A), bile duct tract reestablished (B, C), fully covered self-expandable metal stent dilating the biliary stricture (D), and an endoscopic cholangiogram following stent retrieval (E).

Reference

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