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

doi:10.21203/rs.3.rs-3876173/v1

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Research Article

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

https://doi.org/10.21203/rs.3.rs-3876173/v1

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Journal Publication

published 22 Oct, 2024

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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.

Post-cholecystectomy

Hepatobiliary

Endoscopic retrograde cholangiopancreatography

Recent trends have shown a slight increase in the incidence of gallstone disease in Nigeria and other African countries (1–4). The rise in the incidence, which may be real or apparent, has been associated with changes in diets from traditional high-fiber diets to more westernized diets as well as increased use of hormonal contraception (2, 5). Most patients with gallstone disease are asymptomatic. However, approximately 20% of these asymptomatic gallstones will develop symptoms over 15 years of follow-up. These gallstones may go on further to develop complications such as cholecystitis, cholangitis, choledocholithiasis, gallstone pancreatitis, and rarely cholangiocarcinoma (6).

Cholecystectomy, with or without common bile duct exploration, is the treatment of choice for gallstone disease and its complications (7). These surgeries can be performed by open or laparoscopic approach. Until recently, most centers in Nigeria performed surgery by open approach; however, few centers have mastered laparoscopic surgery. Worldwide, laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease (8, 9). Both the laparoscopic and open cholecystectomy approaches are at risk of complications (10). Common complications following cholecystectomy include biliary injury, which can lead to bile leak or biliary strictures, retained common bile duct (CBD) stones, post-cholecystectomy syndrome, post-cholecystectomy diarrhea, vascular injury/bleeding, abscess formation, and bowel injury (10, 11). Of these, biliary injury and retained common bile stones are the most common, requiring urgent intervention. The bile duct injury could be major or minor (12).

The occurrence of these complications is associated with significant morbidity, mortality, and significant financial burdens (13). Early recognition and prompt management are associated with better outcomes. Early recognition can be made by close clinical monitoring of the patient, and this can be confirmed by radiological investigation such as an abdominal ultrasound scan, Computerized Tomography (CT) scan, and Magnetic Resonance Cholangiopancreatography (MRCP). While a few of these patients who had post-cholecystectomy complications will require salvage surgery, most of the patients can be managed endoscopically where the facilities and skills are available. Endoscopic therapy is nowadays widely recommended as first-line therapy (14). Endoscopic therapy includes sphincterotomy, stenting, and the placement of nasobiliary drains (15). All these therapeutic procedures can be done during Endoscopy Retrograde Cholangiopancreatography (ERCP). The endoscopic intervention aims to eliminate the pressure gradient across the Sphincter of Oddi, promoting preferential bile flow into the duodenum and allowing the leak to heal (16).

Surgery was the only treatment modality available in Nigeria until 2018, when ERCP was introduced in our center. Morbidity and mortality associated with repeat surgery in those patients is usually high except in a specialized center (17, 18). Since the introduction of ERCP, patients with complications following post-cholecystectomy with or without common bile duct exploration were referred to our center. This study presents our initial experience managing such patients, highlighting the endoscopic procedures performed and their outcomes at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.

Study Design and Location

The prospective study was conducted at the Gastrointestinal Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, from February 2018 to April 2023. The unit received referrals of patients with biliary injury post cholecystectomy from all over Nigeria and Ghana. The institution has facilities for both ERCP and open surgery.

Sample size and Sampling Technique

All consecutive cases referred to the unit for ERCP and therapeutic endoscopic interventions post cholecystectomy within the reference period formed the subjects of the study. Patients who had bile leaks post-liver surgery were excluded from the study.

Data Collection

Data was collected using a standard proforma designed for the study. Data collected included demographic characteristics and previous hospitalization due to biliary pathology, time of surgery and presentation, last treatment before presenting, clinical presentation, site of the leak and associated conditions on ERCP, the various therapeutic endoscopic interventions, the one-month post-procedure outcome and complications related to these interventions were collated.

Before the ERCP, all patients had undergone preliminary investigations like hemogram, PT/PTT, INR, liver function tests, renal function tests, blood glucose levels, serology for HIV, Hepatitis C and B, and ultrasonography of the abdomen. Most patients also had an abdominal CT scan and MRCP before the procedure. Routinely, electrolyte and clotting factor derangement were corrected before the procedure. As indicated, the clotting factor derangement was updated using Vitamin K and fresh frozen plasma. Those that had peritonitis from bile leak at presentation were managed with peritoneal washout and drain insertion at laparotomy to control the leak before ERCP.

The clinical details and imaging features were reviewed at multidisciplinary meetings to assess the appropriateness of the referral and the pre-operative diagnosis. The multidisciplinary meeting comprised endoscopists, radiologists, anesthesiologists, nurses, and their trainees.

ERCP was performed under general anesthesia with cuffed endotracheal intubation administered with most of the patients placed in a prone position except when patients’ conditions did not allow for such. In that case, the procedure was performed supine. The procedures were performed using the Evis Exera II Video duodenoscope TjfQ180V. Carm was used for real-time fluoroscopic visualization of the biliary tree after injection of contrast agent into the biliary tree. The contrast agent used was Scanlux^R 370 mg/ml, which contains 755 mg/ml of Iopamidol as the active substance. This was diluted with normal saline in equal proportions before the injection.

Selective cannulation of the CBD was attempted using standard sphincterotome and hydrophilic guidewire (Boston Scientific Corp., Natick, MA, USA). If initial attempts at cannulation were unsuccessful, cannulation was tried using an ERCP cannula. Precut was performed using a needle knife to facilitate access to the biliary tree if the previous effort failed. Cholangiography was used to assess for evidence of biliary tree abnormality, such as extravasation of bile to suggest biliary leak, biliary stricture, or filling defect to suggest retained stone (Fig. 1). For those with bile leak, sphincterotomy and a removable plastic biliary stent (7Fr or 10Fr by 9cm or 7cm) or fully covered self-expanding metal stent were inserted to allow anterograde drainage. The location of the lesion and availability of the stent generally guide the length of the stent. Any other abnormal findings at ERCP (e.g., retained stones) were treated as required. The abdominal external drains inserted at laparotomy for patients with bile leaks were removed as soon as the drain became inactive following ERCP. Patients with incomplete stricture had the following procedure, which included insertion of a plastic stent or metal stent and dilatation of the stricture using a hurricane balloon. ERCP was repeated within six weeks to 3 months after the resolution of the biliary leak. Cholangiography was used to confirm the healing of the biliary fistula and the absence of a biliary stricture or other pathology such as choledocholithiasis. All the patients who had complete stricture of the biliary tree had surgery – Roux-en-Y hepaticojejunostomy. Percutaneous biliary drainage (PTBD) was used for those unsuitable for surgery. Because most of the patients were referred from other institutions, they were all sent back to their primary institutions after the completion of treatment. However, our research staff followed up with the patient on the phone for one month after the procedure. The criteria used to determine the resolution of complications include clinical features with normalization of liver function tests, cessation of external drain output (when present), and resolution of intraabdominal collection on follow-up ultrasound with no further complications.

Data were analyzed using the IBM SPSS Statistics for Windows, version 22.0 Armonk, NY: IBM Corp. Categorical variables were presented as frequencies and percentages. The data were presented in tables and charts. Continuous variables such as age and the duration of symptoms were presented as median and range. ERCP and fluoroscopic images were also preserved to demonstrate findings from the procedure further. Presenting complaints were classified into four categories – recurrent ascending cholangitis, peritonitis, persistent bile fistula, and jaundice. Patients presenting with recurrent ascending cholangitis were those that presented with a constellation of recurring symptoms such as upper abdominal pain, fever with chills and rigor, and intermittent jaundice. These patients had been admitted multiple times before referral and were placed on antibiotics each time they had symptoms. Patients classified as having peritonitis were those that have uncontrol bile leak leading to bilious peritonitis at presentation. Patient who had peritonitis had abdominal pain, abdominal distension, bile leak from the wound, etc. All these patients had laparotomy and peritoneal lavage, as well as insertion of an abdominal external drain(s) to control the leak before performing ERCP. ERCP was performed electively in all clinically stable patients, usually within five days of the surgical intervention. Patients with persistent fistula are those that had bile duct injury at the referring hospital and subsequently had open or laparoscopic peritoneal lavage and insertion of abdominal drain to control the bile leak. Two patients who had open cholecystectomy and common bile duct exploration with insertion of T-tubes complicated by biliary fistula were categorized as having persistent biliary fistula. Patients with Jaundice were those who developed jaundice after cholecystectomy with no significant fever or upper abdominal pain. These patients had elevated serum bilirubin and deranged liver enzymes following cholecystectomy.

Ethical Consideration

This study was approved by the Ethics and Research Review Board of Obafemi Awolowo University Teaching Hospitals Complex (protocol number ERC/2019/01/08). All participants signed an informed consent as approved by the board.

Forty-five patients [(12 (26.7%) men and 33 (73.3%) women] with a median age of 39 (range 8–63 years) who were referred on account of post-cholecystectomy complications were included in the study. Seventy-two ERCPs were performed on these patients, accounting for 9.0% of 800 ERCPs performed during the study period. Of the 45 patients, laparoscopic cholecystectomy was carried out in 23 (51.1%) patients, open cholecystectomy in 20 patients (44.4%), and two patients (4.4%) had open cholecystectomy and common bile duct exploration with insertion of T tube.

As shown in Table 1, the most common mode of presentation was ascending cholangitis [16 (35.6%)], followed closely by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms post-cholecystectomy before referral was 20 weeks, with a range of 1-162 weeks. However, the median duration of symptoms for patients who present with recurrent ascending cholangitis was 42 weeks (range 12–162 weeks); the median duration of symptoms for patients with peritonitis was 2.5 weeks (range 1–6 weeks); the median duration for patients with fistula was 4.5 weeks (range 2–24); and the median duration of symptoms for patients presenting with jaundice was 36 weeks (range 3-108 weeks).

Table 1

Baseline Characteristics of the Patients
Parameters	Values (%)
Age (yrs)	39 (range 8–63)
Sex (male/female)	12/33 (26.7/73.3)
Type of Surgery
Laparoscopic Cholecystectomy	23 (51.1)
Open cholecystectomy	20 (44.4)
Open cholecystectomy with CBD exploration and T-tube insertion	2 (4.4)
Number of cases per year
2018	2 (4.4)
2019	8 (17.8)
2020	6 (13.3)
2021	10 (22.2)
2022	12 (26.7)
2023 (Jan – April)	7 (15.6)
Mode of Presentation
Ascending cholangitis	16 (35.6)
Persistent bile fistula	12 (26.7)
Jaundice	11 (24.4)
Peritonitis	6 (13.3)
Duration of symptoms (weeks)	20 (range 1-162)
Preoperative diagnosis
Retained stone post cholecystectomy	16 (35.6)
Biliary stricture	12 (26.7)
Bile leak	11 (24.4)
Minor bile leak	10 (90.9)
Major bile leak	1 (9.1)
Bile leak with stricture	4 (8.9)
Minor bile leak	10 (90.9)
Major bile leak	1 (9.1)
Persistent bile leak from T-tube	2 (4.4)
Treatment
Stone extraction	24 (53.3)
Stent insertion	20 (44.4)
Roux-en -hepaticojejunostomy	12 (26.6)
Stricturoplasty	4 (8.9)
PTBD	1 (2.2)

Following clinical and radiological evaluation, the most common post-cholecystectomy complication was retained stone post-cholecystectomy [16 (35.6%)]. Other diagnoses included bile stricture, bile leak, bile leak with stricture, and persistent bile leak from T tube, 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%), respectively. The two patients with persistent bile leaks from the T tube had CBD stones (Fig. 2). The stones were removed using an extraction balloon. The t-tubes were removed 48 hours after ERCP. A plastic stent was placed in one of the patients, which was removed after six weeks.

For patients with retained stones post-cholecystectomy, 10 of the 16 patients (62.5%) had the stones extracted with extraction balloons, and 5 (31.3%) had stone extraction and placement of plastic stents, which were removed after six weeks. They had multiple stones we could not extract at the first attempt. One patient had placement of a plastic stent to relieve the leak and jaundice pending surgery due to the size of the stone. Endoscopically, the biliary stones measured about 2 cm in diameter (Fig. 3).

Five of eleven patients with bile leaks leaked from the cystic duct with no other injury to the biliary tree (Fig. 4). 4/5 of the patients had plastic stents, while one had a fully covered self-expanding metal stent placement. Another 5/11 (45.5%) of the patients with bile leaks had balloon stone extraction and placement of plastic stents. The leaks were mainly from the cystic ducts due to distal obstruction from the stones. One nine-year-old patient had a complete transection of the bile duct. He was referred to an interventional radiologist for percutaneous biliary drainage. The patient was eventually referred to a transplant surgeon outside the country for surgery due to lack of facilities to operate on paediatric patients with bile duct injury.

Most of the patients (8/12) who had bile duct stricture had open cholecystectomy. Similarly, 10/12 patients with bile duct stricture had complete stricture of the biliary tree and eventually had hepaticojejunostomy. The remaining 2 out of 12 patients had incomplete strictures dilated using hurricane balloons and stent placements (Figs. 4 and 5). One patient had a plastic stent placed, and the other had a fully covered ten by 8cm self-expanding metal stent. The ability of the patient to pay for the procedure and availability was the deciding factor for the two patients. When a plastic stent was used, we preferably placed a 10Fz by 9cm plastic stent. Eight surgical procedures were performed at OAUTHC, while two patients elected to have their surgery in an HPB surgery center outside the country.

Of the four patients who had bile leak with stricture, two patients each had open cholecystectomy and laparoscopic cholecystectomy. They all had balloon dilatation of the strictures and placement of plastic stents. One of the patients had three procedures, while one was referred for surgery, which was performed at the referring center.

The ampullary cannulation rate in this group of patients was 100%. One patient had mild acute pancreatitis, which was managed conservatively and was discharged after four days. One patient with bile duct stricture had stent migration and eventually had hepaticojejunostomy due to a recurrence of the stricture. One patient, however, died. The patient had a biliary fistula and CBD stones post-laparoscopic cholecystectomy. The patient was referred for ERCP 4 months after laparoscopic cholecystectomy. He presented with an abdominal external drain producing about 400–600 mls of bile each day. He had plastic stents placed during the first ERCP. The external drain was removed 48 hours after ERCP. He had the second ERCP after 12 weeks when he had stones extracted from the biliary tree and removal of the plastic stent. He was discharged after 48 hours of the second ERCP but readmitted with features suggestive of peritonitis five days following the second ERCP. He died before salvage surgery could be performed.

We present our growing experience in managing patients with post-cholecystectomy complications. To our knowledge, this report on endoscopy management of post-cholecystectomy complications is the first from Nigeria and possibly the first from the West African sub-region. A recent review of Endoscopy capacity in West Africa revealed that ERCP is not routinely performed (19). Given the recent increase in the number of cholecystectomies being performed in our environment due to the increasing burden of gallstones, there will be a growing need for the simultaneous development of salvage procedures in the West African sub-region. This becomes very relevant because a few of the patients with post-cholecystectomy complications are not very stable enough to withstand surgery.

Surgical outcomes in West African countries are inferior (20). The same report highlighted ‘failure to rescue’ as one of the cardinal reasons for poor outcomes following surgery in Africa. Surgical complications are known to occur globally. However, few patients succumb to the complications primarily due to the availability of facilities and skill sets for prompt recognition and treatment of the complications. Outside West Africa, many countries have developed minimally invasive techniques to manage mishaps following cholecystectomy. In recent years, endoscopic and percutaneous interventions have essentially replaced surgery as first-line treatment for most post-cholecystectomy complications. The management of the patients, including the specific approach, is usually influenced by local expertise and the type and severity of the injury (11). With the increasing drift toward minimal access surgical procedure for gallstone disease in the West African subregion and its expected attendant increase in the incidence of biliary injury following the surgery, it is essential to develop an endoscopic and percutaneous intervention in the West African subregion (14, 21, 22).

Our data showed that yearly cases have increased steadily except during the COVID pandemic lockdown. This may not necessarily mean that the incidence of post-cholecystectomy complications is rising in Nigeria, as many reasons may explain this observation. The awareness of the availability of ERCP is growing in the country; hence, many patients who would have had unnecessary surgery are now being referred for ERCP. Similarly, patients who would have traditionally been referred for treatment outside the country are now being referred to our center. This is helping us to build critical numbers to train gastroenterologists and surgeons in the skill set.

It is surprising to know that a good number of the patients with these complications had open surgeries. Open surgery is the salvaging technique in case the laparoscopic approach becomes very difficult. If the number of complications from open surgery equals that of the laparoscopic approach, it suggests that there is an urgent need to train surgeons in the country on the act of performing safe open procedures. Until recently, the number of cholecystectomies performed in most institutions is very low, thus making it very difficult for most general surgeons to be adequately familiar with the procedure before becoming an independent surgeon. Does it also suggest that patients requiring cholecystectomy in Nigeria should be referred to regional centers to be able to grow the number needed to train our new generation of surgeons? Unfortunately, many of our patients will be lost to alternative medical practitioners because of their unwillingness to travel out of their environment for treatment. Currently, treatment is out of pocket in Nigeria. Traveling to a regional center will increase the patient's traveling costs and, eventually, the cost of care. Establishing regional centers for cholecystectomy may subsequently be cheaper at the end of the day when the cost of managing post-cholecystectomy complications is factored in.

The most common complication in our series is retained stone in the biliary tree following the surgery. This may suggest that most patients were not adequately prepared for the procedure. To reduce the cost of care, most surgeons only perform abdominal USS before cholecystectomy. While abdominal USS in good hands may provide adequate information on whether there is a stone in the biliary tree before going for cholecystectomy, it is operator-dependent. When some basic tell-tale signs are observed, such as multiple gallstones, dilated biliary tree, elevated alkaline phosphatase, and Gamma-glutamyl Transferase (GGT), such patients should have other imaging modalities such as Abdominal MRI/MRCP and abdominal CTscan to evaluate the biliary tree. It is better to assume there is a stone in the bile duct when the picture is not clear than to proceed with the surgery. As found in this series, the risk of bile duct leak increases significantly when there is concomitant bile duct stone.

The ampullary cannulation rate recorded in this series should not be interpreted to suggest that ERCP is a simple procedure with little complication. Another report from our group has shown that our ampulla cannulation rate is about 91% (23). ERCP is a complex procedure with a steep learning curve. It can also be associated with significant morbidity, such as pancreatitis, bleeding, stent migration, etc. The risk of pancreatitis is high in patients with stone disease (24). Hence, all therapeutic endoscopists should use good monitoring strategies for any complications. In our series, only mild pancreatitis was seen in a young lady managed for retained stone in the bile duct. She was treated conservatively with bowel rest, fluid, analgesics, and antibiotics. After stent removal following treatment for bile leak and bile duct stone, special attention should be placed on such patients before discharge. We recorded mortality in one patient who had a bile leak from the cystic duct post-cholecystectomy. Occlusion cholangiography was performed, which revealed no leak. Unfortunately, the patient leaked, and before presenting in the hospital, the patient developed irreversible shock. Subsequently, we give our patient detailed instructions on telltale signs of danger and the need to present early.

Another important finding of this study is the duration of the symptoms before presenting for ERCP. The median duration of symptoms was 20 weeks. Except for one patient with a bile leak that presented within one week of the surgery, many were delayed in the referring center. After laparotomy in most of the referring centers and the placement of external drains, many patients were left for weeks in anticipation of the closure of the leak. Our group advised that such patients should be referred as soon as they are stable for quick intervention. This will reduce the hospital stay and the number of work hours lost to this complication.

Unfortunately, the technique deployed for each patient is influenced by the prosthesis's availability and the procedure's cost. Since our patients pay out of pocket, we deployed multi-modal techniques to treat our patients. Several studies have shown that sphincterotomy alone may be sufficient in some patients with bile leaks (14, 25). We performed sphincterotomy on all our patients, and many had stents placed. The duration between the first and second procedure also varies widely in our patients because most need to look for money to pay for the procedure. We could also not provide adequate information on the optimum time to plan the second procedure. However, many authors believe the double-stage procedure should be done within three months (11, 26).

The study is not without limitations. The number of cases was small, and most patients had open surgeries. It, however, provides baseline data on the effectiveness of endoscopic therapy in managing post-cholecystectomy complications in Nigeria. We found the procedure safe and reduced the number of needless surgeries such patients are exposed to. We recommended prompt referral of such patients for ERCP.

Authors’ Contributions

AOI conceptualizes the study, conducts the procedure (ERCP), and records the findings. EA and AWA also performed some of the ERCPs. AOI and APA wrote the initial draft of the manuscript. AOI and APA cleaned and analyzed the data. OAD conducted a radiological investigation and collected the data of the radiological findings. All authors critically review the initial draft of the manuscript. All authors contributed to the writing of the final draft of the manuscript.

Conflict of Interest: All authors declare no conflict of interest.

Funding: The study was self-sponsored.

Data availability: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Ibitoye BO, Adisa AO, Makinde ON, Ijarotimi AO. Prevalence and complications of gallstone disease among pregnant women in a Nigerian hospital. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2014;125(1):41-3.
Eze CU, Ezugwu EE, Ohagwu CC. Prevalence of Cholelithiasis Among Igbo Adult Subjects in Nnewi, Southeast Nigeria:A Community-Based Sonographic Study. Journal of Diagnostic Medical Sonography. 2017;33(2):83-90.
Gyedu A, Adae-Aboagye K, Badu-Peprah A. Prevalence of cholelithiasis among persons undergoing abdominal ultrasound at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. African health sciences. 2015;15 1:246-52.
Idowu BM, Onigbinde SO, Ebie IU, Adeyemi MT. Gallbladder diseases in pregnancy: Sonographic findings in an indigenous African population. J Ultrason. 2019;19(79):269-75.
Nimanya S, Ocen W, Makobore P, Bua E, Ssekitooleko B, Oyania F. Prevalence and risk factors of gallstone disease in patients undergoing ultrasonography at Mulago hospital, Uganda. African Health Sciences. 2020;20:383 - 91.
Ibrahim M, Sarvepalli S, Morris-Stiff G, Rizk M, Bhatt A, Walsh RM, et al. Gallstones: Watch and wait, or intervene? Cleve Clin J Med. 2018;85(4):323-31.
Gutt C, Schläfer S, Lammert F. The Treatment of Gallstone Disease. Dtsch Arztebl Int. 2020;117(9):148-58.
EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-81.
Michael Brunt L, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surgical endoscopy. 2020;34(7):2827-55.
Ahmad DS, Faulx A. Management of Postcholecystectomy Biliary Complications: A Narrative Review. Am J Gastroenterol. 2020;115(8):1191-8.
Haidar H, Manasa E, Yassin K, Suissa A, Kluger Y, Khamaysi I. Endoscopic treatment of post-cholecystectomy bile leaks: a tertiary center experience. Surgical endoscopy. 2021;35(3):1088-92.
Hii MW, Gyorki DE, Sakata K, Cade RJ, Banting SW. Endoscopic management of post-cholecystectomy biliary fistula. HPB (Oxford). 2011;13(10):699-705.
Halle-Smith JM, Hodson J, Stevens LG, Dasari B, Marudanayagam R, Perera T, et al. A comprehensive evaluation of the long-term clinical and economic impact of minor bile duct injury. Surgery. 2020;167(6):942-9.
de'Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg. 2021;16(1):30.
Siiki A, Ahola R, Vaalavuo Y, Antila A, Laukkarinen J. Initial management of suspected biliary injury after laparoscopic cholecystectomy. World J Gastrointest Surg. 2023;15(4):592-9.
Rustagi T, Aslanian HR. Endoscopic management of biliary leaks after laparoscopic cholecystectomy. J Clin Gastroenterol. 2014;48(8):674-8.
Rystedt J, Lindell G, Montgomery A. Bile Duct Injuries Associated With 55,134 Cholecystectomies: Treatment and Outcome from a National Perspective. World J Surg. 2016;40(1):73-80.
Schreuder AM, Nunes Vaz BC, Booij KAC, Dieren S, Besselink MG, Busch OR, et al. Optimal timing for surgical reconstruction of bile duct injury: meta-analysis. BJS Open. 2020;4(5):776-86.
Perl D, Leddin D, Bizos D, Veitch A, N'Dow J, Bush-Goddard S, et al. Endoscopic capacity in West Africa. Afr Health Sci. 2016;16(1):329-38.
Biccard BM, Madiba TE, Kluyts HL, Munlemvo DM, Madzimbamuto FD, Basenero A, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. 2018;391(10130):1589-98.
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165(1):9-14.
Smiley KE, Wuraola F, Mojibola BO, Aderounmu A, Price RR, Adisa AO. An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital. Jsls. 2023;27(1).
Alatise OI, Owojuyigbe AM, Omisore AD, Ndububa DA, Aburime E, Dua KS, et al. Endoscopic management and clinical outcomes of obstructive jaundice. Niger Postgrad Med J. 2020;27(4):302-10.
Cahyadi O, Tehami N, de-Madaria E, Siau K. Post-ERCP Pancreatitis: Prevention, Diagnosis and Management. Medicina (Kaunas, Lithuania). 2022;58(9).
Garcés-Albir M, Martí-Fernández R, Martínez-Fernández G, Peña-Aldea A, Muñoz Forner E, Sanchiz-Soler V, et al. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2019;111(9):690-5.
Sachdev A, Kashyap JR, D'Cruz S, Kohli DR, Singh R, Singh K. Safety and efficacy of therapeutic endoscopic interventions in the management of biliary leak. Indian J Gastroenterol. 2012;31(5):253-7.

No competing interests reported.

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

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