Laparoscopic treatment of complications from endoscopic retrograde cholangiopancreatography.

Abstract

Complications after endoscopic retrograde cholangiopancreatography (ERCP) usually are treated endoscopically or by traditional surgical procedure. We present two cases of laparoscopic treatment. Patient l had mechanical jaundice. Ultrasound scan showed a common bile duct (CBD) extended to 11 mm, and ERCP disclosed a stone wedged up in the extrapancreatic part of the CBD. Endoscopic techniques did not help to remove the stone, and finally tore off the Dormia basket, leaving it in the bile ducts. After unsuccessful attempts at its endoscopic evacuation, laparoscopy was performed. A choledochoscope was introduced into the CBD, and the Dormia basket was removed. However, the removal of the stone "ingrown" in the wall of the CBD was not successful, leading to a laparotomy. Patient 2 had cholecysto- and choledocholithiasis. On ERCP, multiple stones filling the CBD were found. Combining ECRP with extracorporeal shock-wave lithotripsy, sphincterotomy, and mechanical lithotripsy did not lead to removal of all the stones, so an endoscopic biliary prosthesis was introduced. During consecutive ERCP, one of the prosthetic ends moved into the head of pancreas. Endoscopic attempts to remove it were unsuccessful, so laparoscopy was performed. During the operation, the CBD was incised, allowing all the remaining stones and the prosthetic device to be removed successfully. It seems that laparoscopic treatment currently may be an alternative to traditional surgery in the treatment of some complications after ERCP.