This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (71)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Diagnostic and Therapeutic Application of Endoscopic Retrograde Cholangiopancreatography

Richard Kozarek, MD; Robert Gannan, MD; Richard Baerg, MD; James Wagonfeld, MD; Terrance Ball, MD

Arch Intern Med. 1992;152(5):1040-1043.

Abstract
Background.—
Laparoscopic cholecystectomy, introduced less than 2 years ago, is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. The primary interaction of endoscopic retrograde cholangiopancreatography with this technology is usually in the preoperative or postoperative diagnosis and treatment of common bile duct stones.

Methods. —
During a 12-month period, 597 patients under-went laparoscopic cholecystectomy by 20 general surgeons at six Puget Sound (Wash) hospitals. All patients with symptomatic postoperative biloma diagnosed by abdominal ultrasound or computed tomography with or without endoscopic retrograde cholangiopancreatography, as well as those who had acute bile duct injury diagnosed and repaired at the time of cholecystectomy, were retrospectively reviewed.

Results.—
Three bile duct transections were acutely recognized and treated with hepaticojejunostomy. Fourteen additional patients presented within 7 days with biloma, three of whom were treated with percutaneous drainage alone. Of the remaining 11 patients who underwent endoscopic retrograde cholangiopancreatography, six were noted to have common bile duct injuries; two, bile duct transections; and 3, cystic duct leaks that required a variety of endoscopic or surgical therapies. In all, 17 (2.9%) of 597 patients sustained a bile duct injury and, to date, seven (1.2%) of 597 patients required surgery for such injury.

Conclusions.—
In a regional setting, laparoscopic cholescystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology.

(Arch Intern Med. 1992;152:1040-1043)

Author Affiliations
From the Section of Gastroenterology, Virginia Mason Medical Center, Seattle, Wash (Drs Kozarek and Ball); Sections of Gastroenterology, Swedish Hospital, Seattle, and Overlake Hospital, Bellevue, Wash (Dr Gannan); and Section of Gastroenterology, Tacoma General Hospital, Humana Hospital, and St Joseph's Hospital and Health Care Center, Tacoma, Wash (Drs Baerg and Wagonfeld).

Footnotes
Accepted for publication November 27, 1991.

Reprint requests to Virginia Mason Clinic, PO Box 900, Seattle, WA 98111 (Dr Kozarek).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Using Contrast-Enhanced MR Cholangiography with IV Mangafodipir Trisodium (Teslascan) to Evaluate Bile Duct Leaks After Cholecystectomy: A Prospective Study of 11 Patients
Vitellas et al.
Am. J. Roentgenol. 2002;179:409-416.
ABSTRACT | FULL TEXT  

Complications of Laparoscopic Surgery-Cholecystectomy
Rhodes
SURG INNOV 1997;4:147-153.
ABSTRACT  

Laparoscopic and Open Cholecystectomy Outcomes in Medicare Beneficiaries in Member States of the Large State PRO Consortium
Samkoff and Wu
American Journal of Medical Quality 1995;10:183-189.
ABSTRACT