Early post-operative endoscopy after biliary tract surgery.

Area of Science:

• Gastroenterology
• Surgical Endoscopy

Background:

• Biliary tract surgery can lead to immediate post-operative complications.
• Obstructive jaundice, biliary fistulae, and gastrointestinal hemorrhage are common issues.
• Endoscopic diagnosis and treatment offer a less invasive alternative to re-laparotomy.

Purpose of the Study:

• To evaluate the efficacy of early post-operative endoscopic retrograde cholangiopancreatography (ERC) and esophago-gastro-duodenoscopy.
• To assess the diagnostic and therapeutic capabilities of endoscopy for biliary tract surgery complications.
• To determine if endoscopic interventions can obviate the need for re-laparotomy.

Main Methods:

• A retrospective analysis of 94 patients undergoing early post-operative ERC or esophago-gastro-duodenoscopy between 1972 and 1979.
• Endoscopic procedures were utilized for diagnosis and treatment of complications following biliary tract surgery.
• Specific interventions included papillotomy and endoscopic control of bleeding.

Main Results:

• ERC successfully identified causes of bile flow obstruction and leakage.
• Successful endoscopic retrograde cholangiopancreatography-guided papillotomies were performed in 75 patients for residual gallstones and 4 for overlooked stenoses.
• Complete stone removal was achieved in 72 cases, and bleeding from stress ulcers was controlled in two patients.

Conclusions:

• Early post-operative endoscopy, particularly ERC, is a valuable tool for diagnosing and managing complications after biliary tract surgery.
• Endoscopic treatment, including papillotomy and hemostasis, can effectively resolve issues like residual stones and bleeding, often avoiding repeat surgical procedures.
• The study highlights the therapeutic potential of endoscopic interventions in the early post-operative period for biliary tract surgery patients.