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Gastroenterology Research and Practice
Volume 2016 (2016), Article ID 6293538, 6 pages
http://dx.doi.org/10.1155/2016/6293538
Review Article

Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

II Unit of General Surgery, Luigi Sacco Hospital, Department of Biochemical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy

Received 30 June 2015; Accepted 23 August 2015

Academic Editor: Michel Kahaleh

Copyright © 2016 M. Crespi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.