Lw. Traverso et al., ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AFTER LAPAROSCOPIC CHOLECYSTECTOMY, The American journal of surgery, 165(5), 1993, pp. 581-586
We assessed the use of endoscopic retrograde cholangiopancreatography
(ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary re
ferral center. This assessment included patients from outside institut
ions with post-LC problems. Between May 1990 and September 1992, we pe
rformed 522 LCs and 1,723 ERCP examinations. There were 78 patients, w
ho underwent 143 ERCP examinations after LC, 65% of whom were referred
. ERCP findings, were categorized as follows: normal results (8%), pro
blems inherent to stone disease (65%), and iatrogenic injury (27%). Th
e types of inherent problems were common bile duct (CBD) stones, pancr
eatitis, and papillary stenosis/microlithiasis. Within the CBD stone g
roup, 5 of 26 patients also had papillary stenosis, and, within the pa
ncreatitis group, 9 of 11 patients also had papillary stenosis, making
papillary stenosis the most frequent observation (55%). Almost all of
these patients (96%) required endoscopic papillotomy for successful t
reatment. The iatrogenic injury group was comprised of 21 patients, 16
% of whom had cystic duct leak and 84% of whom had CBD injury. These p
atients required a variety of endoscopic procedures including endoscop
ic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drai
nage of biloma (29%), and percutaneous transhepatic biliary drainage (
24%). Open surgical procedures after endoscopic assessment or treatmen
t were required in only three patients in the iatrogenic group and in
none in the inherent group. At this time, long-term follow-up is not p
ossible with regard to biliary stricture. We conclude that the majorit
y of problems after LC are either due to papillary stenosis/microlithi
asis with or without CBD stones or to biliary injury. Both can be succ
essfully diagnosed and treated with endoscopic techniques.