Vnitr Lek 2007, 53(11):1182-1189

Endoscopic diagnosis and treatment of biliary complications after laparoscopic cholecystectomy

B. Kianička^1,*, P. Dítě², I. Suškevič³

¹ Gastroenterologické oddělení FN u sv. Anny v Brně, přednosta prim. MUDr. Bohuslav Kianička, Ph.D.

² Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc.

³ Klinika zobrazovacích metod Lékařské fakulty MU a FN u sv. Anny v Brně, přednosta doc. MUDr. Petr Krupa, CSc.

Objective of study:
The main parameters studied in this retrospective study were the success of diagnoses carried out using endoscopic retrograde cholangiopancreatography (ERCP), the ability of ERCP to precisely determine the cause of complications and the effectiveness and morbidity of therapeutic ERCP.


Materials and method:
the study covers a period of 7 years (January 1997 - December 2003). The study retrospectively reviewed the histories of 92 patients who underwent laparoscopic cholecystectomy (LCE) and subsequently developed symptoms suggesting possible biliary complications (BC) from previous LCE, and indicating the performance of ERCP.

Results:
diagnostic ERCP was successful for all 92 patients (i.e. in 100% of cases). In 5 patients the ERCP found normal conditions. In the remaining 87 patients, the ERCP found pathological conditions corresponding to some form of biliary complication. Choledocholithiasis was detected in 59 patients, bile leakage from the cystic duct stump was found in 11 patients, bile leakage from the extrahepatic bile duct was found in 4 patients, biliary stenosis in the common hepatic duct was found in 5 cases and 8 patients had blockages of the extrahepatic bile duct. 10 patients out of 87 received only diagnostic ERCP and all 10 underwent surgery immediately following diagnosis. 77 out of 87 patients with established BC underwent endoscopic therapy after diagnostic ERCP. Therapeutic ERCP was entirely successful for 73 patients out of 87 with BC after LCE (83.92%), and did not require other modalities of treatment such as surgical or transhepatic procedures.

Conclusions:
In our sample the success rate for therapeutic ERCP was 83.92%. Morbidity relating to therapeutic ERCP was 3.9%. ERCP was shown to be highly effective in both diagnosing and treating BC after LCE.

Keywords: ERCP; laparoscopic cholecystectomy; biliary compliations; endoscopic therapy

Published: November 1, 2007  Show citation