BILE-DUCT INJURY AFTER LAPAROSCOPIC CHOLECYSTECTOMY - THE VALUE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

This study describes the value of endoscopic retrograde cholangiopancr eatography (ERCP) in patients with bile duct injury after laparoscopic cholecystectomy. Twelve consecutive patients were studied over a one year period. In all patients the biliary tree was visualised during ER CP. Four patients had complete bile duct obstruction, seven patients h ad a stricture (two with concomitant leakage), and one patient had lea kage from a hepatic branch. Three patients with complete obstruction, presented with a relatively prolonged symptom free, 'silent' period be fore diagnosis. In all four patients with complete transection, a prox imal hepaticojejunostomy was performed. In one patient with a tough fi brous stricture, secondary to incorrect clip placement, passage of the guidewire was impossible, leaving surgical reconstruction as the only therapeutic option. All remaining seven patients with leakage or stri ctures, or both were successfully treated by endoscopic sphincterotomy only (n=1) or sphincterotomy and subsequent stent placement (n=6). Wh en patients do not recover uneventfully after laparoscopic cholecystec tomy even without cholestasis or jaundice, early ERCP is recommended a s a safe and valuable method to detect bile duct injury and to suggest treatment. Subsequently, more than half of such patients can be treat ed endoscopically. Extended follow up is needed to evaluate the longte rm results.