Endoscopic management of bile duct complications after cholecystectomy

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Abstract
The introduction of laparoscopic cholecystectomy appeared to be associated in many institutions with an increased incidence of biliary injury. Therefore, over a period of one year we prospectively collected the data of all patients who were referred to our unit with a suspected bile duct problem after cholecystectomy. Between August 1992 and August 1993, 32 patients with endoscopically identified problems were included in the study. Twenty-three out of 32 had early complications (occurred within the first 30 days after cholecystectomy). Thirteen out of these 23 patients showed a bile leakage, 7 retained stones and 2 duct strictures and in 1 patient the hepatic duct was clipped. Only 10/23 early bile duct problems occurred after laparoscopic cholecystectomy. 19/23 patients (82%) were treated successfully on the endoscopic route. All 11 patients with late complications had strictures associated in 7 cases with stones. All late complications appeared after open surgery. Endoscopic or percutaneous therapy was successful in 7/11 patients (63%). With the exception of one minor bleeding, no major complication occurred. Summing up, endoscopic therapy is the therapy of choice in the case of bile duct problems after cholecystectomy with a high success rate and low complication rate. To date, in our area there are no clear indications that bile duct problems after laparoscopic surgery are more frequent than after open cholecystectomy.