title: Endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy.
abstract: We assessed the use of endoscopic retrograde cholangiopancreatography (ERCP) after laparoscopic cholecystectomy (LC) at our hepatobiliary referral center. This assessment included patients from outside institutions with post-LC problems. Between May 1990 and September 1992, we performed 522 LCs and 1,723 ERCP examinations. There were 78 patients who underwent 143 ERCP examinations after LC, 65% of whom were referred. ERCP findings were categorized as follows: normal results (8%), problems inherent to stone disease (65%), and iatrogenic injury (27%). The types of inherent problems were common bile duct (CBD) stones, pancreatitis, and papillary stenosis/microlithiasis. Within the CBD stone group, 5 of 26 patients also had papillary stenosis, and, within the pancreatitis group, 9 of 11 patients also had papillary stenosis, making papillary stenosis the most frequent observation (55%). Almost all of these patients (96%) required endoscopic papillotomy for successful treatment. The iatrogenic injury group was comprised of 21 patients, 16% of whom had cystic duct leak and 84% of whom had CBD injury. These patients required a variety of endoscopic procedures including endoscopic papillotomy (67%), CBD endoscopic stenting (76%), percutaneous drainage of biloma (29%), and percutaneous transhepatic biliary drainage (24%). Open surgical procedures after endoscopic assessment or treatment were required in only three patients in the iatrogenic group and in none in the inherent group. At this time, long-term follow-up is not possible with regard to biliary stricture. We conclude that the majority of problems after LC are either due to papillary stenosis/microlithiasis with or without CBD stones or to biliary injury. Both can be successfully diagnosed and treated with endoscopic techniques.
authors: Department of Surgery, Virginia Mason Medical Center, Seattle, Washington 98111.
authors: L W
authors: LW
authors: Traverso
authors: R A
authors: RA
authors: Kozarek
authors: T J
authors: TJ
authors: Ball
authors: J J
authors: JJ
authors: Brandabur
authors: J A
authors: JA
authors: Hunter
authors: P C
authors: PC
authors: Jolly
authors: D J
authors: DJ
authors: Patterson
authors: J A
authors: JA
authors: Ryan
authors: R C
authors: RC
authors: Thirlby
authors: D G
authors: DG
authors: Wechter
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000150:complications / Q000628:therapy*; D003135:Common Bile Duct / Q000293:injuries; D003251:Constriction, Pathologic / Q000628:therapy; D005500:Follow-Up Studies; D042882:Gallstones / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D010195:Pancreatitis / Q000628:therapy