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Endoscopy 1997; 29(5): 341-348
DOI: 10.1055/s-2007-1004213
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

What Role Can Endoscopy Play in the Management of Biliary Complications after Laparoscopic Cholecystectomy?

F. Prat1 , G. Pelletier1 , T. Ponchon2 , J. Fritsch1,3 , B. Meduri3 , J. Boyer4 , B. Person4 , J.-F. Bretagne5
  • 1Hepatology and Gastroenterology Service, Centre Hospitalier Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
  • 2Dept. of Digestive Specialties, Edoward Herriot Hospital, Lyons, France
  • 3Digestive Endoscopy Service, Foch Hospital, Suresnes, France
  • 4Hepatogastroenterology Service, Centre Hospitalier Universitaire d'Angers, Angers, France
  • 5Hepatogastroenterology Service, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
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Publication History

Publication Date:
17 March 2008 (online)

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Abstract

Background and Study Aims: This study was carried out to establish the indications for biliary endoscopy due to biliary complications after laparoscopic cholecystectomy (LC).

Patients and Methods: One hundred nineteen patients (36 men, 86 women; median age 59, range 16-93) were referred for endoscopic retrograde cholangiopancreatography (ERCP) to five centers between 1990 and 1994, and included in the study. The delay between LC and ERCP was 105 ± 21 days.

Results: Four types of complications were observed, a) Fifty-seven patients had residual stones or clip migration into the common bile duct (CBD); all were successfully treated with endoscopic sphincterotomy (ES). b) Twelve major injuries to the CBD were diagnosed by ERCP; successful surgical repair was carried out in most of these cases, c) Twenty patients had a partial biliary stricture; endoscopic stenting was attempted as a primary procedure in eight patients, with a satisfactory outcome in five (63 %). d) Thirty patients had a bile leak; endoscopic therapy (26 patients) led to recovery in 18 (69 %). The benefit of endoscopic treatment was less clear in five (19 %); ES failed to bring about improvement in three patients (12 %).

Conclusions: ERCP is indicated when a biliary complication is suspected after laparoscopic cholecystectomy. Endoscopic sphincterotomy is effective for the treatment of retained stones, clip migration, and bile leakage. Endoscopic stenting may be offered as a primary option in partial CBD strictures.

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