The Role of Endoscopic Retrograde Cholangiopancreatography in the Management of Biliary Complication Post-Laparoscopic Cholecystectomy

Mohamed Abdzaid Akool; Samer Makki Mohamed Al-Hakkak; Alaa Abood  Al-Wadees

doi:10.3889/oamjms.2021.6071

Authors

Mohamed Abdzaid Akool Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq
Samer Makki Mohamed Al-Hakkak Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq https://orcid.org/0000-0002-7001-7188
Alaa Abood Al-Wadees Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq

DOI:

https://doi.org/10.3889/oamjms.2021.6071

Keywords:

Cholangiopancreatography, Biliary complications, Laparoscopic cholecystectomy, Cholecystolithiasis, Endoscopic retrograde cholangiopancreatography

Abstract

BACKGROUND: Laparoscopic cholecystectomy considers a golden surgery for gallbladder removal nowadays, and it carries some complications like biliary injuries, which can manage successfully by endoscopic retrograde cholangiopancreatography.

AIM: To estimate the role of endoscopic management of bile duct injury (BDI) following laparoscopic cholecystectomy.

PATIENT AND METHODS: A prospective study conducted at Al-Sader Medical City, Najaf City, Iraq, during the period between September 2018 and December 2020, included 44 patients complicated by the biliary injury resulting in a persistent biliary leak and/or jaundice after laparoscopic cholecystectomy and evaluated by endoscopic retrograde cholangiopancreatography (ERCP).

RESULTS: Findings revealed that 25% of cases had complete BDI, only one managed by plastic stent placement, the other 10 referred for open surgical constructions, 61% had partial injury associated with the biliary leak, all managed by sphincterotomy and plastic stent placement through ERCP, almost 7% had a partial clipping of bile duct all managed with sphincterotomy, balloon dilatation/stone extraction, and plastic stent placement, 5% had slipped clips of cystic duct stump, are managed with sphincterotomy and plastic stent placement. Moreover, only one patient, 2%, had distal common bile duct stone with bile leak, managed by sphincterotomy and stone extraction.

CONCLUSIONS: Laparoscopic cholecystectomy, a gold standard therapeutic option for symptomatic cholecystolithiasis, is associated with an increased risk of biliary injury due to many factors. ERCP is a safe means of diagnosing the cause of bile leakage after laparoscopic cholecystectomy. It also offers definitive treatment in most cases by endoscopic sphincterotomy and plastic stent placement.

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References

Pham TH, Hunter JG. Gallbladder and the extrahepatic biliary system. In: Schwartz Principles of Surgery. 9th ed., Vol. 32. New York: McGraw-Hill; 2010.

Fletcher DR. Gallstones. Modern management. Aust Fam Physician 2001;30:441.

Giger U, Ouaissi M, Schmitz SF, Krahenbuhl S, Krahenbuhl L. Bile duct injury and use of cholangiography during laparoscopic cholecystectomy. Br J Surg. 2011;98(3):391-6. https://doi.org/10.1002/bjs.7335 PMid:21254014 DOI: https://doi.org/10.1002/bjs.7335

Shamiyeh A, Wayand W. Laparoscopic cholecystectomy: Early and late complications and their treatment. Langenbecks Arch Surg. 2004;389(3):164-71. https://doi.org/10.1007/s00423-004-0470-2 PMid:15133671 DOI: https://doi.org/10.1007/s00423-004-0470-2

Nuzzo G, Giuliante F, Giovannini I, Ardito F, D’Acapito F, Vellone M, et al. Bile duct injury during laparoscopic cholecystectomy: Results of an Italian National Survey on 56 591 cholecystectomies. Arch Surg. 2005;140(10):986-92. https://doi.org/10.1001/archsurg.140.10.986 PMid:16230550 DOI: https://doi.org/10.1001/archsurg.140.10.986

Zha Y, Chen XR, Luo D, Jin Y. The prevention of major bile duct injures in laparoscopic cholecystectomy: The experience with 13,000 patients in a single centre. Surg Laparosc Endosc Percutan Tech. 2010;20(6):378-83. https://doi.org/10.1097/sle.0b013e3182008efb PMid:21150413 DOI: https://doi.org/10.1097/SLE.0b013e3182008efb

Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P. Long-term results and risk factors influencing the outcome of major bile duct injuries following cholecystectomy. Br J Surg. 2005;92(1):76-82. https://doi.org/10.1002/bjs.4775 PMid:15521078 DOI: https://doi.org/10.1002/bjs.4775

Kapoor VK. Management of bile duct injuries: A practical approach. Am Surgeon. 2009;75(12):1157-60. PMid:19999903 DOI: https://doi.org/10.1177/000313480907501201

Gossage JA, Forshaw MJ. Prevalence and outcome of litigation claims in England after laparoscopic cholecystectomy. Int J Clin Pract. 2010;64(13):1832-5. https://doi.org/10.1111/j.1742-1241.2009.02200.x PMid:21070534 DOI: https://doi.org/10.1111/j.1742-1241.2009.02200.x

Gigot JF, Etienne J, Aerts R, Wibin E, Dallemagne B, Deweer F, et al. The dramatic reality of biliary tract injury during laparoscopic cholecystectomy: An anonymous multicenter Belgian survey of 65 patients. Surg Endosc. 1997;11(12):1171-8. https://doi.org/10.1007/s004649900563 PMid:9373288 DOI: https://doi.org/10.1007/s004649900563

Strasberg SM, Helton WS. An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford). 2011;13(1):1-14. https://doi.org/10.1111/j.1477-2574.2010.00225.x PMid:21159098 DOI: https://doi.org/10.1111/j.1477-2574.2010.00225.x

Cuschieri SA, Steele RJ, Moossa AR. Biliary tract disease. In: Cuschiery’s Essential Surgical Practice. 4th ed., Vol. 28. London: Arnold; 2002.

Feldman M, Friedman L, Brandt L. Biliary tract disease: Endoscopic and radiological treatment. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 9th ed., Ch. 70. Amsterdam, Netherlands: Elsevier; 2010. https://doi.org/10.1016/b978-1-4160-6189-2.00133-5 DOI: https://doi.org/10.1016/B978-1-4160-6189-2.00133-5

Carr-Locke DL. Therapeutic role of ERCP in the management of suspected common bile duct stones. Gastrointest Endosc. 2002;56(Suppl 6):S170-4. https://doi.org/10.1067/mge.2002.129024 PMid:12447262 DOI: https://doi.org/10.1067/mge.2002.129024

Baron TH. Endoscopy for bile duct stones. Minerva Gastroenterol Dietol. 2005;51(4):289-301. PMid:16282958

Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Germanidis G, Zavos C, et al. A comparative study of 10-Fr vs 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc. 2008;22:101-6. https://doi.org/10.1007/s00464-007-9381-y PMid:17516115 DOI: https://doi.org/10.1007/s00464-007-9381-y

Machado NO. Biliary complications post laparoscopic cholecystectomy: mechanism, preventive measures, and approach to management. Diagn Ther Endosc. 2011;2011:967017. https://doi.org/10.1155/2011/967017 PMid:21822368 DOI: https://doi.org/10.1155/2011/967017

Harboe KM, Bardram L. The quality of cholecystectomy in Denmark: Outcome and risk factors for 20,307 patients from the national database. Surg Endosc. 2011;25(5):1630-41. https://doi.org/10.1007/s00464-010-1453-8 PMid:21136118 DOI: https://doi.org/10.1007/s00464-010-1453-8

Harrison VL, Dolan JP, Pham TH, Diggs BS, Greenstein AJ, Sheppard BC, et al. Bile duct injury after laparoscopic cholecystectomy in hospitals with and without surgical residency programs. Surg Endosc. 2011;25(6):1969-74. https://doi.org/10.1007/s00464-010-1495-y PMid:21136094 DOI: https://doi.org/10.1007/s00464-010-1495-y

Christos P, Mavromatis TN, Kourlaba GC, Kapiris SA, Bairamides EG, Spyrou AM, et al. Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy? Surg Endosc. 2008;22(9):1959-64. https://doi.org/10.1007/ s00464-008-9943-7 PMid:18443865 DOI: https://doi.org/10.1007/s00464-008-9943-7

Al-Kubati WR. A clinical study of bile duct injury following laparoscopic cholecystectomy. Saudia J Gastroenterol. 2010;16(2):100-4. https://doi.org/10.4103/1319-3767.61236 PMid:20339179 DOI: https://doi.org/10.4103/1319-3767.61236

Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227(4):461-7. https://doi.org/10.1097/00000658-199804000-00001 PMid:9563529 DOI: https://doi.org/10.1097/00000658-199804000-00001

Boddy AP, Bennett JM, Ranka S, Rhodes M. Who should perform laparoscopic cholecystectomy? A 10-year audit. Surg Endosc. 2007;21(9):1492-7. https://doi.org/10.1007/s00464-007-9291-z PMid:17484005 DOI: https://doi.org/10.1007/s00464-007-9291-z

Prakash K, Jacob G, Lekha V, Venugopal A, Venugopal B, Ramesh H. Laparoscopic cholecystectomy in acute cholecystitis. Surg Endosc. 2002;16(1):180-3. https://doi.org/10.1007/s004640080193 PMid:11961635 DOI: https://doi.org/10.1007/s004640080193

Abdel-Raouf A, Hamdy E, El-Hanafy E, El-Ebidy G. Endoscopic management of postoperative bile duct injury. Saudia J Gastroenterol. 2010;16(2):19-24. https://doi.org/10.4103/1319-3767.58763 PMid:20065569 DOI: https://doi.org/10.4103/1319-3767.58763

Christoforidis E, Goulimaris I, Tsalis K, Kanellos I, Demetriades H, Betsis D. The endoscopic management of persistent bile leakage after laparoscopic cholecystectomy. Surg Endosc. 2002;16(5):843-6. https://doi.org/10.1007/s00464-001-9091-9 PMid:11997834 DOI: https://doi.org/10.1007/s00464-001-9091-9

Bose SM, Mazumdar A, Singh V. The role of endoscopic procedures in the management of post-cholecystectomy and post-traumatic biliary leak. Surg Today. 2001;31(1):45-50. https://doi.org/10.1007/s005950170219 PMid:11213042 DOI: https://doi.org/10.1007/s005950170219

Karvonen J, Gullichsen R, Laine S, Salminen P, Groὅnroo JM. Bile duct injuries during laparoscopic cholecystectomy: Primary and long-term results from a single institution. Surg Endosc. 2007;21(7):1069-73. https://doi.org/10.1007/s00464-007-9316-7 PMid:17514397 DOI: https://doi.org/10.1007/s00464-007-9316-7