Comparison of Sphincterotomy Alone Versus Sphincterotomy and Biliary Stent Placement for the Treatment of Post-Laparoscopic Cholecystectomy Biliary Leaks

Background: While a number of endoscopic procedures have demonstratedefficacy in the management of post-cholecystectomy biliary leakage (PCBL),the optimal treatment is still up for debate. Endoscopic biliary stenting (BS) with or without endoscopic sphincterotomy (ES), nasobiliary tube drainage with or without ES, and endoscopic sphincterotomy alone (ES) are among the endoscopic procedures that have been employed.Aim: Our research aims to assess the safety and effectiveness of biliarystenting in addition to endoscopic sphincterotomy vs sphincterotomy alone forthe management of biliary leakage following laparoscopic cholecystectomy.Patients and methods: The study comprised 50 patients in total, dividedinto two groups of 25 patients each, who had been diagnosed with postlaparoscopiccholecystectomy biliary leakage. Of them, 25 had endoscopicsphincterotomy alone, and 25 underwent endoscopic sphincterotomy plusthe implantation of a biliary stent. The effectiveness of each patient’s therapywas then monitored clinically. Results: There were six cases among the group I patients where ES alonewas ineffective; four underwent surgical treatment, and two were successfullytreated with stent implantation thereafter. Out of the 25 group II patients,only 2 cases (8%), required surgery to repair the leak following ERCP. Forgroups I and II, the total complication rate was 8% and 16%, respectively. Conclusion: While the ES alone group had a reduced risk of adverseevents, biliary stent + ES is more efficacious than ES alone for the treatmentof post-laparoscopic cholecystectomy biliary leakage. As a result, thepreferred method for endoscopic therapy of PCBL should be ERCP with stentimplantation plus ES, even if it necessitates a further endoscopic procedureto remove the biliary stent.