Abstracts: CLINICAL VIGNETTES/CASE REPORTS - PANCREATIC/BILIARY
Concurrent Endoscopic and Laparoscopic Approach for Management of Early Latrogenic Bile-Duct Obstruction
Purpose: Common bile duct (CBD) occlusion secondary to inadvertent application of surgical clip is one of the serious complications of cholecystectomy. Diagnosis is usually established during endoscopic retrograde cholangiopancreatography (ERCP), however if diagnosed in early post-operative period, multiple sessions of endoscopic therapy is often required. Failure of initial attempt at endoscopic therapy warrants either percutaneous transhepatic cholangiography and/or surgical exploration. In this case-series, we describe a novel approach of management of these patients by simultaneous endoscopic and laparoscopic method.
Methods: Three consecutive patients diagnosed with complete or near-complete obstruction of CBD following laparoscopic cholecystectomy (LC) were identified for inclusion.
Results: The mean age of patients was 45.3 years. All the patients presented between 5-7 days following LC. The diagnosis of obstructed CBD was established by ERCP. Guidewire failed to negotiate across the obstruction in one of these patients. In another patient, guidewire could be passed, but a biliary stent could not be deployed across the obstruction. In a third patient, only a single biliary stent (7F × 15) could be placed across the obstruction. Based on these findings, simultaneous ERCP and laparoscopy was performed immediately to remove the clips and/or sutures from the bile-duct by laparoscopic approach followed by the placement of biliary stents by endoscopic approach in all the patients. Concomitant bile-leak was diagnosed in two of these patients following the removal of surgical staples from CBD. All the patients were asymptomatic at the follow-up ranging from 1-1.5 years. The liver functions were normal at the follow-up.
Conclusion: Concurrent endoscopic and laparoscopic approach for the management of acute iatrogenic CBD obstruction is associated with improved and rapid recovery. It avoids the need for multiple ERCP's required with the endoscopic approach alone in the management of these injuries.© The American College of Gastroenterology 2012. All Rights Reserved.