ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Alison L. Kent, Michael R. Cox, Thomas G. Wilson, Robert T. A. Padbury, James Toouli

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Laparoscopic cholecystectomy is the preferred method of treatment for symptomatic choledocholithiasis. Since its introduction there has been an increase in postoperative diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to assess the indications and results of ERCP following laparoscopic cholecystectomy. Sixty‐one patients had an ERCP following laparoscopic cholecystectomy. Two broad groups were identified: Group 1 (35 patients) had filling defects (consistent with stones) noted on operative cholangiography, which were not successfully flushed or extracted at the time of laparoscopic cholecystectomy; Group 2 consisted of patients who developed problems following laparoscopic cholecystectomy. Nine patients had post‐laparoscopic cholecystectomy pain with abnormal liver function tests (LFT), four of whom had common bile duct (CBD) injuries and three had CBD stones. Eleven patients had post‐laparoscopic cholecystectomy pain with a normal diameter common bile duct on ultrasound and normal LFT; only one had a CBD stone. Five patients with a persisting bile leak following laparoscopic cholecystectomy had an ERCP and endoscopic sphincterotomy. In three the leak ceased, while two required subsequent open surgery to drain bile collections and ligate the cystic duct. One patient presented with an episode of transient jaundice but had a normal ERCP. There were six post‐ERCP complications; three patients had mild pancreatitis, two had a minor haemorrhage and one an asymptomatic duodenal perforation. Endoscopic retrograde cholangiopancreatography post‐laparoscopic cholecystectomy was most valuable for the management of retained stones and the diagnosis and management of post‐laparoscopic cholecystectomy pain in association with abnormal LFT. The diagnostic yield was low (9%) when the LFT were normal.

Original languageEnglish
Pages (from-to)407-412
Number of pages6
JournalAustralian and New Zealand Journal of Surgery
Volume64
Issue number6
DOIs
Publication statusPublished - Jun 1994
Externally publishedYes

Keywords

  • bile duct injury
  • choledocholithiasis
  • endoscopic retrograde cholangiopancreatography
  • endoscopic sphincterotomy
  • laparoscopic cholecystectomy.

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