Endoscopic treatment of laparoscopic bile duct injuries.

Laparoscopic technique has become the norm for cholecystectomy, one of the most commonly performed operations. Unfortunately, the advent of laparoscopic cholecystectomy has been accompanied by a significant increase in bile duct injuries and a new set of postsurgical problems when compared with traditional, open cholecystectomy. Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as a central method for diagnosis and treatment of bile duct injuries and other problems arising after laparoscopic cholecystectomy. The most common biliary problems include bile leaks from the cystic duct remnant or one of the main ducts; ductal injury, such as disruption or strictures; retained common bile duct stones; or postoperative biliary-pancreatic pain. Building on the success of endoscopic treatment of biliary complications of traditional surgery, ERCP, in cooperation with radiological and surgical intervention, can facilitate definitive diagnosis and treatment of bile leaks and simple strictures. Complex strictures and complete disruptions are not amenable to endoscopic therapy and should be treated surgically. As experience in laparoscopic cholecystectomy increases, the incidence of bile duct injuries should decline; ERCP, however, will remain a valuable adjunctive modality.