[Endoscopic interventions of the biliary tract in postoperative complications after cholecystectomy for preventing...

The postoperative complication rate of laparoscopic cholecystectomy (LC) is about 5-6%. The most frequent complications are residual gallstones in the common bile duct, biliary leckage, biliary fistula and duct stenosis. In the period between 01.11.94 and 01.04.96 we performed 1620 endoscopic retrograde cholangio pancreatographies including 410 papillotomies at the second Department of Medicine in the Clinic of Suhl. Thereby in 2.1% (34 cases) of patients a complication after laparosopic cholecystectomy was seen and endoscopically controlled. Residual bile duct stones were removed without any problems by papillotomy and stone extraction. Biliary leckage were brigded by stent implantation. In case of aberrant cystic duct it was also possible to implant a stent depending on anatomical situation. All patients were followed up over a period of 6 to 8 month after endoscopic procedure. All except two patients showed an occlusion of biliary leckage and the bile duct stent could be revved. In one case, a younger patient, with a failed endoscopic occlusion of biliary fistula had to undergo a further operation because of residual gallbladder tissue. In the other case, a 84-years old patient, we use a new method, developed at our department, for selective embolization of the cystic duct to prevent a relaparotomy. The leckage was sufficiently closed. Endoscopic intervention is indicated in case of postoperative complication after LC and successful in the majority of cases. This should primarily discussed between surgeon and physician. Only secondarily a relaparotomy should be performed, if endoscopic procedures have failed.