Post-cholecystectomy complications and ERCP

摘要

Objective: To document the spectrum of post- cholecystectomy complications obtained at ERCP in a local population. Methodology: The procedures were carried out at the Radiology department, in collaboration with the department of gastroenterology, Fauji Foundation hospital, Rawalpindi and Valley clinic over a 15-year period from 1 June 1992 to 30th May 2006. We reviewed the diagnostic outcomes of post operative ERCPs. A total of 160 patients underwent ERCPs, all being performed by a single gastroenterologist. Sphincterotomy was performed, when indicated, to establish the drainage of obstructed bile ducts and to permit the spontaneous passage of small residual bile duct calculi. Dormia basket was used to retrieve stones from the CBD in other cases. Results: A total of 160 ERCPs were performed. There were 130 female and 30 male patients in this study. The principal indication for performing ERCP was residual bile duct calculi (n=62) suspected on ultrasonogarphic examination; followed by worsening post operative jaundice. The most common finding at ERCP was the presence of retained CBD stones. The second most common finding was ligation of CBD during cholecystectomy. Endoscopic sphincterotomy was performed in 62 cases Retained stones were suspected in 32 cases on ultrasonogarphic examination while ERCP established the presence of CBD stones in 32 cases in all. Conclusion: The most common etiological diagnostic finding was residual biliary stones; followed by iatrogenic bile duct obstruction. Postoperatively, ERCP should be the preferred method for removing bile duct stones. Sphincterotomy at ERCP is a safe and effective method of managing residual CBD stones. This study again emphasizes the role of ERCP in the diagnosis of post operative complications.