الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study was conducted on thirty patients presented with different post-cholecystectomy complications. Regardless the time of presentation that may be early (within one week post-operative), intermediated (> 1 week - < 6 weeks) or delayed presentation (>6 weeks post-operative). It included nine males and 21 females. Their age ranged between 18 years and 66e years with a median age of 39 years.
The aim of this work was to evaluate the role of intervention radiology to manage different post-cholecystectomy complications either as sequele to open or laparoscopic cholecystectomy, performed inside or outside our institute then the patients were referred to the Intervention Radiology Unit, Alexandria Main University Hospital.
All patients were subjected to full history taking and thorough clinical assessment, dedicated laboratory tests, different diagnostic imaging modalities including U/S, abdominal CT (in 19 cases) and MRCP (in 23 cases).
As regards the management, the total number of cases who required surgical repair (13/30=43.3%), three cases (3/30=10%) required further endoscopic management, the remaining 14 patients (14/30=46.7%), the minimally invasive interventions were the gold-standard techniques in the management of different post-cholecystectomy complications using different percutaneous or angiographic approaches with no need for further surgical intervention.
As regard these different intervention modalities used in this study, fifteen cases (15/30=50%) required drainage of their biloma or intra-hepatic cholangitic abscesses using U/S guided (in 14 cases) or CT guided (in one case) percutaneous drainage. Ten cases initially managed by PTD then referred back for surgical repair (eight of them managed by PTD-E, and the remaining two cases managed by PTD-IE). Six cases (6/30=20%) were successfully managed by PTD-IE drain, followed by cholangioplasty, caliber upgrading and assessment of their biliary flow using the biliary manometric perfusion test as final step to define the end point, to allow safe removal of the drains with less risk of re-stenosis and recurrence. In (2/13=15.4 %) we have had successful insertion of PTD-IE at the 1st session, followed by internal stenting (PTD-I) at the next session after successful cholangioplasty.
Two patients with abdominal bulge (incisional hernia); one of them required preoperative progressive pneumo-peritoneum for its adhesiolysis effect.
Only one case (1/30=3.3%) presented with severe attacks of melena, haematemsis with marked DROP in hemoglobin level (Hb= 4.8 gm/dl). Endoscopic assessment revealed haemobilia, triphasic liver CT revealed right hepatic artery pseudo-aneurysm, confirmed by conventional angiography where the patient managed at the same session by selective embolization of the pseudo-aneurysm using hystoacryl, preserving the whole hepatic arterial tree.
So In our study we found that there were a lot of factors that determine selection of The treatment of these injuries as it’s complex and requires expert multidisciplinary teams, therefore it is best to refer patients to centers capable of advanced endoscopic, radiologic, and hepatobiliary surgical techniques, regardless of the potential superiority of one technique over the other.