Diagnostic and therapeutic interventions in post-laparoscopic cholecystectomy biliary complications.
Radiological imaging and therapeutic interventions were performed in eight patients with biliary complications following laparoscopic cholecystectomy. The diagnostic approach and the outcome of the therapeutic procedures were evaluated. Complications observed were bile leakage from the cystic duct stump (n = 2); erroneous identification of the cystic duct leading to common hepatic duct transection (n = 1) and hepatic duct ligation (n = 2); liver abscess (n = 1); and retained common duct stones (n = 2). Diagnostic ultrasonography is capable of detecting the presence of abnormal fluid collection and the diameter of the common duct with or without the presence of a stone, although bile leaks and retained common duct stones can only be demonstrated by either endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Once a bile leak had been confirmed, therapeutic endoscopic biliary stenting was successfully applied in one patient while the other received percutaneous transhepatic biliary drainage. Definitive diagnosis of retained common duct stone was established by endoscopic retrograde cholangiopancreatography, and immediate endoscopic sphincterotomy with stone extraction was performed. Follow-up radiological imaging was done to determine the effectiveness of the therapeutic procedures applied in each patient. All our patients improved clinically, and further surgical intervention was not needed.
Yau
M P
MP
Department of Surgery, Tainan Municipal Hospital, Taiwan, R.O.C.
Tsai
C C
CC
Mo
L R
LR
Lin
R C
RC
Kuo
J Y
JY
Lin
Y W
YW
Hwang
M H
MH
D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003549:Cystic Duct / Q000293:injuries; D004322:Drainage; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000628:therapy; D006500:Hepatic Duct, Common / Q000293:injuries; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D016717:Sphincterotomy, Endoscopic