COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY - COORDINATED RADIOLOGIC AND SURGICAL-MANAGEMENT IN 21 PATIENTS

The authors describe their experience in management of bile duct injur ies (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) a s complications of laparoscopic cholecystectomy in 21 patients. Clinic al presentations included jaundice, sepsis, pain, abdominal distention , and persistent gallstones. Twelve patients underwent operative chola ngiography, three underwent conversion to open cholecystecteomy, and 1 2 reoperations were performed in nine patients before interventional r adiologic procedures, which included diagnostic percutaneous transhepa tic cholangiography (n = 13), percutaneous biliary drainage (PBD) (n = 13), percutaneous stricture dilation (n = 3), stent insertion (n = 1) , percutaneous abscess or biloma drainage (n = 19), and gallstone remo val (n = 1). Each procedure was technically successful. Clinical impro vement occurred in 18 of 19 patients. PBD was used as an operative gui de before reconstructive surgery in two patients. Reoperations was unn ecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provid ed rapid and safe management of these complications.