title: Complications following endoscopic retrograde cholangiopancreatography: minimal invasive surgical recommendations.
abstract: BACKGROUND
  ERCP has a complication rate ranging between 4% and 16% such as post-ERCP pancreatitis, hemorrhage, cholangitis and perforation. Perforation rate was reported as 0.08% to 1% and mortality rate up to 1.5%. Besides, injury related death rate is 16% to 18%. In this study we aimed to present a retrospective review of our experience with post ERCP-related perforations, reveal the type of injuries and management recommendations with the minimally invasive approaches.
  
  
  METHODS
  Medical records of 28 patients treated for ERCP-related perforations in Okmeydani Training and Research Hospital between March 2007 and March 2013 were reviewed retrospectively. Patient age, gender, comorbidities, ERCP indication, ERCP findings and details were analyzed. All previous and current clinical history, laboratory and radiological findings were used to assess the evaluation of perforations.
  
  
  RESULTS
  Between March 2007 and March 2013, 2972 ERCPs were performed, 28 (0.94%) of which resulted in ERCP-related perforations. 10 of them were men (35.8%) and 18 women (64.2%). Mean age was 53.36 ± 14.12 years with a range of 28 to 78 years. 14 (50%) patients were managed conservatively, while 14 (50%) were managed surgically. In 6 patients, laparoscopic exploration was performed due to the failure of non-surgical management. In 6 of the patients that ERCP-related perforation was suspected during or within 2 hours after ERCP, underwent to surgery primarily. There were two mortalities. The mean length of hospitalization stay was 10.46 ± 2.83 days. The overall mortality rate was 7.1%.
  
  
  CONCLUSIONS
  Successful management of ERCP-related perforation requires immediate diagnosis and early decision to decide whether to manage conservatively or surgically. Although traditionally conventional surgical approaches have been suggested for the treatment of perforations, laparoscopic techniques may be used in well-chosen cases especially in type II, III and IV perforations.
authors.affiliation: Department of Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Koc
authors.affiliation: Department of Surgery, Baskent University Faculty of Medicine, Istanbul Research Hospital, Istanbul, Turkey.
authors.forename: Huseyin Yuce
authors.initials: HY
authors.lastname: Bircan
authors.affiliation: Department of Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Adas
authors.affiliation: Department of Surgery, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kemik
authors.affiliation: Department of Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Akcakaya
authors.affiliation: Department of Radiology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Yavuz
authors.affiliation: Department of Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Karahan
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods* / Q000706:statistics & numerical data; D002761:Cholangitis / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis