USE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE MANAGEMENT OF BILIARY COMPLICATIONS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Background. Current options in the management of bile duct injuries ca used by laparoscopic cholecystectomy include diagnostic and therapeuti c endoscopic retrograde cholangiopancreatography (ERCP) and open lapar otomy with direct repair. The goal of this review was to clarify the r ole and evaluate the potential of endoscopic techniques to diagnose an d treat bile duct injuries. Methods. The records of all patients under going biliary tract surgery at our hospitals for the period from Decem ber 1989 to February 1993 were reviewed. Twenty-five patients were ide ntified with bile duct injuries during laparoscopic cholecystectomy. R esults. ERCP was performed for diagnostic or therapeutic purposes in 2 2 of the 25 patients; successful opacification of the biliary tree was achieved in 21 (95%) of the 22 patients. In these 21 patients the loc ation and nature of the injury were identified correctly in 19 (90%). In six of the 25 cases, interventional ERCP was used as the primary tr eatment of these injuries. Successful treatment was achieved in five ( 83%) of the six cases, although laparotomy was required in two to drai n the abscess cavity better. Open surgical repair was performed as the primary treatment in the remaining 19 patients. Interventional ERCP w ith stenting was required in six and transhepatic stenting in one of t hese patients as an adjunctive treatment for structure or persistent f istula. Six (86%) of these seven patients have been treated successful ly to date in this manner. Conclusions. ERCP is a uniquely helpful dia gnostic and therapeutic technique in the management of laparoscopic bi liary complications. Open surgical repair remains the procedure of cho ice for patients with loss of bile duct tissue or long complex strictu res. ERCP with sphincterotomy, balloon dilatation, and stenting is an accepted alternative approach for bile leaks (fistulas) and treatment of shorter structures resulting from either the initial laparoscopic i njury or the initial repair.