Postcholecystectomy problems and the role of endoscopic retrograde cholangiopancreatography.

Many patients continue to have symptoms even after cholecystectomy. We studied 4 patients with postcholecystectomy problems over a period of seven years; 208 were females, males and their mean age was 41.8 years (range 14-70). Presenting symptoms were abdominal pain (217), jaundice (74), cholangitis (38) and external biliary fistula (eight). Fifteen patients also had a t-tube in situ. Endoscopic retrograde cholangiopancreatography was successfully performed in 239 patients and revealed abnormal findings in 179. These included: stones (89), strictures (53), choledochoduodenal fistula (10), choledochal cyst (three), biloma (three), ligation of bile duct (five), ascaris in bile duct (three), pancreatitis (nine), long cystic duct stump (11), and various other findings. Endoscopic sphincterotomy was carried out in 59 patients with stones. Seven patients with strictures were managed with stents. Ascaris in the bile duct of three patients was removed with the help of a Dormia basket. To conclude, stones and strictures are common postcholecystectomy problems and endoscopic retrograde cholangiopancreatography is very helpful in the diagnosis and management of postcholecystectomy patients.