Post written by Dong Ki Lee, MD, PhD, from the Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

This video shows the process and the result of magnetic compression anastomosis (MCA) for treating a biliary stricture after cholecystectomy that could not be treated with conventional methods.

A cholangiogram showed bile leakage on the surgical clip and right hepatic duct stricture in a 60-year-old woman who underwent laparoscopic cholecystectomy because of a gallbladder stone. The bile leakage was resolved by the insertion of a fully covered self-expandable metallic stent.

However, the hepatic duct stricture could not be treated with conventional methods because guidewire could not be passed through the stricture. The MCA method was applied to form a new fistula and recanalize the stricture. This case shows that MCA may be useful in treating complete biliary stricture after cholecystectomy.

Endoscopic or percutaneous treatment cannot be successful when it is impossible to place a guidewire through the postcholecystectomy stricture, owing to complete obstruction and severe stricture in the bile duct. In these cases, patients should have an external drainage catheter or undergo re-operation. MCA is safe and feasible in the management of biliary strictures occurring after various operations.

This video can give important information about MCA to readers. Other endoscopists can understand the method of MCA and consider applying it for treating biliary strictures that cannot be treated using conventional methods.  

We hope the MCA method will resolve biliary strictures for patients and improve their quality of life.

Cholangiogram showed bile leakage on the surgical clip and right hepatic duct stricture.

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