Endoscopic management of complications from laparoscopic cholecystectomy
- Michael K Sanders, MD
Michael K Sanders, MD
- Director of Therapeutic Endoscopy
- Springhill Medical Center
Iatrogenic injury to the biliary tree is a well-documented complication of cholecystectomy. This topic review will focus on the role of the endoscopist in the management of these disorders. It is important to appreciate that several injuries, particularly complex hilar lesions or total transections, are usually not amenable to endoscopic treatment. An overview of the complication of laparoscopic cholecystectomy is provided separately. (See "Complications of laparoscopic cholecystectomy".)
INCIDENCE AND DEFINITIONS
The introduction of laparoscopic cholecystectomy and its sudden and widespread implementation in the early 1990s led to a dramatic increase in the frequency of biliary injury. With increasing experience, the incidence of this complication has declined substantially (from 2.2 percent in a report from 1991 to an overall incidence of 0.6 percent from several more recent series) [1-3].
However, the incidence has probably reached a plateau. This was illustrated in a report from a high-volume tertiary referral center, in which the frequency and distribution of bile duct injuries detected by ERCP over a nine-year period (from 1994 to 2003) remained unchanged . The actual incidence of biliary injuries may be higher than the above estimates since not all series classified bile leaks that did not require operative management as a complication.
Successful management of bile duct injury requires a multidisciplinary team approach incorporating experienced biliary endoscopists, interventional radiologists, and hepatobiliary surgeons. The approach to the patient depends upon the nature and extent of the injury, the presence or absence of biloma, and the timing of discovery. Debate continues within the surgical literature as to whether routine intraoperative cholangiography reduces the risk of biliary complications [5,6].
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