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Complications after laparoscopic cholecystectomy

Coordinated radiologic, endoscopic, and surgical treatment

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Abstract

The diagnostic and therapeutic approaches used for patients referred for bile duct injuries and other major complications after laparoscopic cholecystectomy (LC) were reviewed and the results of a coordinated radiologic, endoscopic, and surgical approach were assessed.

From April 1991 to October 1993, 23 patients were observed. Seven patients had biliary strictures, five had biliary lesions, five presented with retained common bile duct (CBD) stones, and one had a minor cystic duct leak. Five patients had miscellaneous abdominal fluid collections; in addition, biloma or bile ascites were present in 10/23 cases. Correct definition of iatrogenic lesions was mainly made by endoscopic retrograde cholangiography (ERCP) (n=15), associated in six cases also with percutaneous cholangiography (PTC). “Minimally invasive” treatment included the full range of endoscopic and interventional radiological procedures. Six patients with biliary strictures, one patient with a biliary lesion, all five patients with residual CBD stones, and four patients with abdominal collections were treated by “minimally invasive” techniques: Therefore, laparotomy was avoided in 70% of cases (16/23 patients). Open surgery was necessary in 7/23 patients (30%), because of ductal lesion (n=4), ductal stricture by endoloop (n=1), iliac artery injury (n=1), and phlegmon of gallbladder bed (n=1).

It appears that careful assessment of complications after LC is mandatory and often requires the combined use of ERCP/PTC and cross-sectional imaging. After a first diagnostic phase, complications should be managed by a multidisciplinary approach wherein the radiologist and the endoscopist strictly cooperate with the surgeon in order to obtain an immediate relief of the initial clinical problem, such as jaundice, bile leak, or infection, and then plan a definitive treatment which is tailored to each patient's problem. Using this approach the whole event of LC and its complications can be managed within the field of minimally invasive therapy in most cases.

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References

  1. Andrén-Sandberg A, Johannson S, Bengmark S (1985) Accidental lesions of the common bile duct II. Results of treatment. Ann Surg 201: 452–455

    Google Scholar 

  2. Adams DB, Borowicz MR, Wootton III FT, Cunningham JT (1993) Bile duct complications after laparoscopic cholecystectomy. Surg Endosc 7: 79–83

    Google Scholar 

  3. Blumgart LH, Kelley CJ, Benjamin IS (1984) Benign bile duct stricture following cholecystectomy: critical factors in management. Br J Surg 71: 836–843

    Google Scholar 

  4. Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387

    Google Scholar 

  5. Gibson RN, Adam A, Yeung E, Savage A, Collier NA, Benjamin IS, Blumgart LH, Allison DJ (1988) Percutaneous techniques in benign hilar and intrahepatic strictures. J Interv Radiol 3: 125–130

    Google Scholar 

  6. Grilliland TM, Traverso LW (1990) Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholecystectomies with emphasis on long-term relief of symptoms. Surg Gynecol Obstet 170: 39–44

    Google Scholar 

  7. Horvath KD (1993) Strategies for the prevention of laparoscopic common bile duct injuries. Surg Endosc 7: 439–444

    Google Scholar 

  8. Kang EH, Middleton WD, Balfe DM, Soper NJ (1991) Laparoscopic cholecystectomy: sonographic evaluation. Radiology 181: 439–442

    Google Scholar 

  9. Kozarek R, Gannan R, Baerg R, Wagerfeld J, Ball T (1992) Bile leak after laparoscopic cholecystectomy. Arch Intern Med 152: 1038–1043

    Google Scholar 

  10. Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H (1991) Laparoscopic injuries to the bile duct: a cause of concern. Ann Surg 215: 203–208

    Google Scholar 

  11. Morgenstern L, Berci G, Pasternak EH (1993) Bile leakage after biliary tract surgery: a laparoscopic perspective. Surg Endoscop 7: 432–438

    Google Scholar 

  12. Mullen JP, Carr RE, Rupnik EJ, Knapp RW (1976) 1000 cholecystectomies, extraductal palpation and operative cholangiography. Am J Surg 131: 672–675

    Google Scholar 

  13. Perissat J, Collet D, Belliard R (1990) Gallstones, laparoscopic treatment-cholecystectomy and lithotripsy. Surg Endosc 4: 1–5

    Google Scholar 

  14. Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KE, Lomano JM, Roby SR, Front ME, Carey LC (1990) Safety and efficacy of laparoscopic cholecystectomy: a prospective analysis of 100 initial patients. Ann Surg 213: 3–12

    Google Scholar 

  15. Peters JH, Gibbson GD, Innes JT, Nichols KE, Front ME, Sheri RR, Ellison EC (1991) Complications of laparoscopic cholecystectomy. Surgery 110: 769–778

    Google Scholar 

  16. Pollack EL, Tabrisky J (1973) The aberrant divisional bile duct: a surgical hazard. Surgery 73: 234–239

    Google Scholar 

  17. Ponsky JL (1991) Complications of laparoscopic cholecystectomy. Am J Surg 161: 393–395

    Google Scholar 

  18. Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy: a comparison with mini-laparoscopic cholecystectomy. Surg Endosc 3: 131–133

    Google Scholar 

  19. Rossi P, Salvatori FM, Bezzi M, Maccioni F, Porcaro ML, Ricci P (1990) Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents. Cardiovasc Intervent Radiol 13: 231–239

    Google Scholar 

  20. Salky BA, Bauer JJ, Kreel I, Gelerent IM, Garfine SR (1991) Laparoscopic cholecystectomy: an initial report. Gastrointest Endosc 37: 1–4

    Google Scholar 

  21. Soper NJ (1991) Laparoscopic cholecystectomy. Curr Probl Surg 28: 587–655

    Google Scholar 

  22. Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. New Eng J Med 324: 1073–1078

    Google Scholar 

  23. Trerotola SO, Savander SJ, Lund GB, Venbrux AC, Sostre S, Lillemoe KD, Cameron JL, Osterman FA (1992) Biliary tract complications following laparoscopic cholecystectomy: imaging and intervention. Radiology 184: 195–200

    Google Scholar 

  24. Walker AT, Shapiro AW, Brooks DC, Braver JM, Tumeh SS (1991) Bile duct disruption and biloma after laparoscopic cholecystectomy: imaging evaluation. AJR. Am J Roentgenol 158: 785–789

    Google Scholar 

  25. Way LW, Bernhoft RA, Thomas MJ (1981) Biliary stricture. Surg Clin North Am 61: 963–972

    Google Scholar 

  26. Zucker KA, Bailey RW, Gadacz TR, Imbembo AL (1990) Laparoscopic cholecystectomy: a plea for cautious enthusiasm. SSAT Plenary Session, San Antonio, Texas

  27. Zucker KA, Bailey RW, Gadacz TR, Imbembo AL (1991) Laparoscopic guided cholecystectomy. Am J Surg 161: 36–44

    Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, III Cattedra, University of Rome “La Sapienza”, 00161, Rome, Italy

    M. Bezzi, F. Orsi, F. M. Salvatori & P. Rossi

  2. Department of Surgery, VII Patologia Chirurgica, University of Rome “La Sapienza”, 00161, Rome, Italy

    G. Silecchia, A. Materia, A. Fantini & N. Basso

  3. Department of Surgery, II Clinica Chirurgica, University of Rome “La Sapienza”, 00161, Rome, Italy

    F. Fiocca

Authors
  1. M. Bezzi
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  2. G. Silecchia
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  3. F. Orsi
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  4. A. Materia
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  5. F. M. Salvatori
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  6. F. Fiocca
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  7. A. Fantini
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  8. N. Basso
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  9. P. Rossi
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Bezzi, M., Silecchia, G., Orsi, F. et al. Complications after laparoscopic cholecystectomy. Surg Endosc 9, 29–36 (1995). https://doi.org/10.1007/BF00187881

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  • DOI: https://doi.org/10.1007/BF00187881

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