| Abstract: | To study how suspected postoperative biliarycomplications are influenced by surgical technique, wecompared clinical profiles of 63 patients referred forERCP after open (OC) and laparoscopic cholecystectomy (LC) over a four-year period. ERCP was notperformed for postoperative pain alone and only six(9.5%) studies were normal. Referrals after LC wereyounger (mean 39.1 vs 53.6 years, P < 0.001) and ERCP was requested earlier (mean 71.6 vs 2360 days,P < 0.001) in the postoperative course.Choledocholithiasis (CDL) alone, the most commonfinding, was successfully managed with a single ERCP in97.2% of cases. CDL after LC occurred in youngerpatients (35.5 vs 58.9 years, P < 0.01) who presentedearlier (mean 98.6 days vs 5.1 years, P < 0.01),without biliary ductal dilatation (P < 0.01).Although CDL after LC was associated with higher ALT andbilirubin levels than after OC, the difference was notstatistically significant. Cystic duct leaks (LC: sixpatients, OC: four patients) were typically associated with CDL after OC and 90% resolved withendoscopic therapy. Biliary ligation (four cases) wasmanaged successfully with choledochojejunostomy. Weconclude that findings at ERCP for suspected biliaryobstruction or injury after OC or LC are similar andusually can be endoscopically managed. After LC,referrals currently are younger, present much earlier,and retained stones are less likely to be associatedwith ductal dilatation than after OC. |
