Multidisciplinary approaches for management of postcholecystectomy problems (surgery, endoscopy, and percutaneous approaches).
OBJECTIVE
A prospective study to evaluate the postcholecystectomy problem management.


METHODS
From March 2005 to April 2007, 210 patients were managed using surgery, endoscopy, and percutaneous approaches.


RESULTS
Endoscopy was therapeutic in 183 cases [stones (81), stricture (55), leakage (35)], and only diagnostic in 24 cases. Percutaneous approaches were carried out in 34 cases as diagnostic in 19 cases, stenting in 2 cases, and combined with endoscopy in 13 cases. Surgery was carried out in 40 cases either urgent in 10 cases (4.8%), or planned in 30 cases (14.3%), for peritoneal lavage in 7 cases, choledocholithotomy in 8 cases, undo ligation and T-tube drainage in 5 cases, common bile duct repair splinted by T tube in 3 cases, choledochoduodenostomy in 1 case, and Roux-en-Y choledochojejunostomy in 18 cases.


CONCLUSIONS
Endoscopy is effective and safe not only for diagnostic but also for therapeutic approaches, especially when combined with percutaneous approaches that help in failure cases, but surgery remains as the gold standard treatment not only for the cases, which failed to be treated by less invasive approaches, but also in cases that are mandatory to be explored as peritonitis.
Redwan
Alaa Ahmad
AA
General Surgery Department, Assuit University Hospitals, Assuit University, Assuit, Egypt. ProfAlaaRedwan@Yahoo.com
D000328:Adult; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D004534:Egypt / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult