Evaluating the impact of different biliary stents for bile leak after fenestrated cholecystectomy: a retrospective multicenter study.

BACKGROUND AND AIMS: Fenestrated cholecystectomy (FC), in which the gallbladder is left open, has been used to reduce the risk of common bile duct (CBD) injury. FC significantly increases the risk of postcholecystectomy bile leak (PCBL). ERCP with CBD stent placement is an effective treatment for PCBL. We aim to compare the efficacy of various stent types in treating bile leak after FC.

METHODS

This retrospective multicenter cohort study included patients who underwent ERCP with biliary stent placement for the management of bile leak after FC. Data were collected, including stent type, size, stent position relative to cystic duct (CD) insertion, and outcome. The primary end point was defined as PCBL resolution on initial follow-up ERCP.

RESULTS

One hundred forty-five patients were included. The most common stent length was 7 cm (100 of 145, 69%). The median time to initial follow-up ERCP showing PCBL resolution was 59 days (IQR, 48-71). There was no difference in PCBL healing based on stent position relative to the CD. PCBL resolution occurred in 106 of 113 patients (93.8%) with 10F stents, 12 of 13 (92.3%) with 7F stents, and 16 of 18 (88.9%) with fully covered self-expandable metal stents (FCSEMSs). Stent diameter had no impact on healing (P = .53). PCBL resolution occurred in 95 of 101 patients (94.1%) with straight plastic stents, 13 of 14 (92.9%) with double-pigtail plastic stents, 11 of 12 (91.7%) with single-pigtail plastic stents, and 16 of 18 (88.9%) with FCSEMSs. Stent type had no impact on PCBL resolution (P = .69).

CONCLUSIONS

To our knowledge, this is the largest cohort studied in this population. There was no significant difference in PCBL healing irrespective of stent type, diameter, length, or positioning relative to the CD. This challenges the belief that a leak from a large fenestrated gallbladder opening requires a large-diameter stent or coverage of the CD. Plastic stents can be effectively used in bile leaks after FC and provide significant cost benefits.