ENDOSCOPIC MANAGEMENT OF BILE-DUCT COMPLICATIONS AFTER CHOLECYSTECTOMY

The introduction of laparoscopic cholecystectomy appeared to be associ ated in many institutions with an increased incidence of biliary injur y. Therefore, over a period of one year we prospectively collected the data of all patients who were referred to our unit with a suspected b ile duct problem after cholecystectomy. Between August 1992 and August 1993, 32 patients with endoscopically identified problems were includ ed in the study. Twenty-three out of 32 had early complications (occur red within the first 30 days after cholecystectomy). Thirteen out of t hese 23 patients showed a bile leakage, 7 retained stones and 2 duct s trictures and in 1 patient the hepatic duct was clipped. Only 10/23 ea rly bile duct problems occurred after laparoscopic cholecystectomy. 19 /23,patients (82%) were treated successfully on the endoscopic route. All 11 patients with late complications had strictures associated in 7 cases with stones. All late complications appeared after open surgery . Endoscopic or percutaneous therapy was successful in 7/11 patients ( 63%). With the exception of one minor bleeding, no major complication occurred. Summing up, endoscopic therapy is the therapy of choice in t he case of bile duct problems after cholecystectomy with a high succes s rate and low complication rate. To date, in our area there are no cl ear indications that bile duct problems after laparoscopic surgery are more frequent than after open cholecystectomy.