TITLE

ENDOSCOPIC MANAGEMENT OF POSTOPERATIVE BILIARY TRAUMA IN A DISTRICT GENERAL HOSPITAL

AUTHOR(S)
Maiden, L.P.; Hurley, P.; Theodossi, A.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA33
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: The role of endoscopic intervention in the management of biliary trauma following cholecystectomy and hepatobiliary surgery in tertiary referral centres has been reported previously. This paper reports the practice of a district general hospital in the management of such cases over a 13 year period. Patients and Methods: Between June 1989 and June 2002, 24 patients (15 female) underwent an endoscopic retrograde cholangiopancreatogram (ERCP) following suspected biliary trauma sustained during hepatobiliary surgery. Mean age was 54 years (range 29-79). Symptoms were of right upper quadrant pain (n = 16), fever (n = 1), jaundice (n = 3), or none (n = 4). Results: At ERCP 14 patients were found to have o leak in the biliary tree and underwent a papillary sphincterotomy and single stent insertion (mean duration = 92 days). 7 had strictures: 2 patients with Bismuth type I strictures required stenting only once and 5 patients with type II or III strictures required multiple stent changes (mean = 3). Symptoms resolved when the stents were finally removed. Three patients had both a biliary leak and a stricture (Bismuth type I in all cases). All 3 required multiple stent changes. 2 out of the 24 (8%) required subsequent surgical intervention in a tertiary referral centre. One patient with a leak and stricture was referred for hepaticojejunostomy 2 years after index ERCP due to a permanent stricture. A patient with 2 strictures was referred for surgery 11 days after ERCP due to continuing symptoms. Complications noted were stent migration (n = 2), ascending cholangitis (n = 1), and acute pancreatitis (n = 2). Conclusion: Postoperative complications of biliary surgery may be managed by therapeutic ERCP effectively and safely in the district general hospital setting. Bile duct leaks and uncomplicated Bismuth type I strictures may both be treated effectively by a single stent for 3 months. Type II and III strictures may require a limited number of stent changes...
ACCESSION #
9747485

 

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