Endoscopic management of post-cholecystectomy complications at a Nigerian tertiary health facility

Abstract

Abstract Background Cholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stone, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center, Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria. Methods All patients with post-cholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, MRCP, and T-tube cholangiogram. All ERCPs were performed under general anesthesia. Results Seventy-two ERCPs were performed on 45 patients referred for post-cholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms post cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common post-cholecystectomy complication seen was retained stone post-cholecystectomy [16 (35.6%)]. Other post-cholecystectomy complications included bile leak, bile stricture, bile leak with stricture, and persistent bile leak from T tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), 2 (4.4%) respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture 10/12 required hepaticojejunostomy. Conclusion Endoscopic management of post-cholecystectomy complications was found to be safe and reduced the number of needless surgeries such patients are exposed to. We recommended prompt referral of such patients for ERCP.