Kenarli Kerem, Ödemiş Bülent, Başpinar Batuhan, Erdoğan Çağdaş, Keskin Emir Tuğrul, Macif Alper, Ünver Nazmi Gökhan
Department of Gastroenterology, University of Health Sciences, Ankara Bilkent City Hospital, Üniversiteler Mahallesi Bilkent Cad. No: 1 Çankaya, Ankara, Turkey.
Department of Gastroenterology, Kilis Prof. Dr. Alaeddin Yavaşca State Hospital, Kilis, Turkey.
Surg Endosc. 2025 Sep;39(9):5916-5926. doi: 10.1007/s00464-025-12013-8. Epub 2025 Aug 5.
Injuries to an aberrant right posterior hepatic duct (ARPHD) are rare but clinically significant complications of cholecystectomy, often resulting in bile leakage and strictures. This study aims to contribute to the limited literature by presenting our findings on the role and effectiveness of endoscopic treatment of ARPHD injuries.
Patients underwent endoscopic treatment for post-cholecystectomy ARPHD injury in a tertiary center between 2008 and 2024 included retrospectively. In addition to standard wire-guided cannulation, rendezvous methods or magnetic compression anastomosis methods were employed. Patient demographics, type of injuries (Strasberg classification), biliary anatomy, endoscopic treatment strategies, and clinical outcomes were analyzed.
A total of 28 patients (53.6% female, mean age 49 years) with ARPHD injuries underwent endoscopic treatment. Strasberg type C was observed in 20 (71.4%) patients, type E5 in 7 (25.0%), and type B in 1 (3.6%). ARPHD cannulation was successful in 90.0% of type C and 85.7% of type E5 cases. All successfully cannulated type C patients achieved leak resolution. Strictures developed in 11 of type C patients after leak resolution and were treated endoscopically. In all type E5 patients, the existing common bile duct and ARPHD strictures were successfully managed endoscopically. In the single type B case, bile duct continuity was restored by magnetic compression anastomosis technique. After a median follow-up of 47 months (range: 3-136), stent-free follow-up was achieved in 75.0% (21/28) of patients after a mean of 4.6 ± 1.2 endoscopic sessions. Three patients, in whom the ARPHD could not be cannulated, required surgery.
Although technically challenging, endoscopic management of ARPHD injuries offers high success in treating bile leaks and strictures, making it a reliable alternative to surgery in most cases.
异常右后肝管（ARPHD）损伤是胆囊切除术中罕见但具有临床意义的并发症，常导致胆汁漏和狭窄。本研究旨在通过展示我们关于ARPHD损伤内镜治疗的作用和有效性的研究结果，为有限的文献做出贡献。
回顾性纳入2008年至2024年在一家三级中心接受内镜治疗胆囊切除术后ARPHD损伤的患者。除了标准的导丝引导插管外，还采用了会师法或磁压榨吻合术。分析患者的人口统计学特征、损伤类型（Strasberg分类）、胆道解剖结构、内镜治疗策略和临床结果。
共有28例ARPHD损伤患者接受了内镜治疗（女性占53.6%，平均年龄49岁）。20例（71.4%）患者为Strasberg C型，7例（25.0%）为E5型，1例（3.6%）为B型。C型患者中90.0%、E5型患者中85.7%的ARPHD插管成功。所有成功插管的C型患者胆汁漏均得到解决。C型患者中有11例在胆汁漏解决后出现狭窄，并接受了内镜治疗。所有E5型患者现有的胆总管和ARPHD狭窄均通过内镜成功处理。在唯一的B型病例中，通过磁压榨吻合术恢复了胆管连续性。中位随访47个月（范围：3 - 136个月）后，平均经过4.6±1.2次内镜治疗，75.0%（21/28）的患者实现了无支架随访。3例无法对ARPHD进行插管的患者需要手术治疗。
尽管技术上具有挑战性，但ARPHD损伤的内镜治疗在治疗胆汁漏和狭窄方面成功率很高，在大多数情况下使其成为手术的可靠替代方法。
