Complications of laparoscopic cholecystectomy: coordinated radiologic and surgical management in 21 patients.
The authors describe their experience in management of bile duct injuries (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) as complications of laparoscopic cholecystectomy in 21 patients. Clinical presentations included jaundice, sepsis, pain, abdominal distention, and persistent gallstones. Twelve patients underwent operative cholangiography, three underwent conversion to open cholecystectomy, and 12 reoperations were performed in nine patients before interventional radiologic procedures, which included diagnostic percutaneous transhepatic 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 removal (n = 1). Each procedure was technically successful. Clinical improvement occurred in 18 of 19 patients. PBD was used as an operative guide before reconstructive surgery in two patients. Reoperation was unnecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provided rapid and safe management of these complications.
vanSonnenberg
E
E
Department of Radiology, University of California, San Diego 92103.
D'Agostino
H B
HB
Easter
D W
DW
Sanchez
R B
RB
Christensen
R A
RA
Kerlan
R K
RK
Moossa
A R
AR
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012086:Reoperation