A 74-year-old man presented with
generalized itching and mild jaundice.
A year earlier, he had undergone a
Laboratory test results included
total bilirubin, 4.2 mg/dL; direct bilirubin,
3.6 mg/dL; alkaline phosphatase,
503 IU/L; aspartate aminotransferase,
841 IU/L; and alanine
aminotransferase, 561 IU/L. Serum
immunoelectrophoresis showed diffuse
hyperglobulinemia; the IgG level
was 2220 mg/dL. The level of tumor
marker CA19-9 was elevated to 550
U/L as a result of chronic cholangitis.
Findings of a CT scan of the abdomen
were normal. Endoscopic
showed a surgical clip obstructing
the common biliary tract. Residual
stones are the leading cause of biliary
obstruction; they occur in up to 2% of
The clip was surgically removed;
the patient's clinical and laboratory
findings gradually improved after the
operation. There has been no recurrence
of biliary obstruction 1 year
after clip removal.
Minimally invasive laparoscopic
cholecystectomy generally is associated with a shorter
hospital stay, fewer complications, less trauma, and a
lower incidence of cardiac and respiratory complications
than open cholecystectomy. 1-5 It is therefore often the procedure
of choice for patients who are at high operative
risk, such as elderly persons and those with cardiac and
respiratory disease. 2,6 Jaundice occurs rarely after the laparoscopic
However, an increased incidence of common bile
duct or hepatic duct injury exists with laparoscopic cholecystectomy.
2,4 Furthermore, these bile duct injuries tend
to be higher in the duct system and more extensive than
those that occur in traditional cholecystectomy; thus, the
likelihood of successful reconstruction is reduced. 8
1. McMahon AJ, Russell IT, Baxter JN, et al. Laparoscopic versus minilaparotomy
cholecystectomy: a randomized trial. Lancet. 1994;343:135-138.
2. Hannan EL, Imperato PJ, Nenner RP, Starr H. Laparoscopic and open cholecystectomy
in New York State: mortality, complications, and choice of procedure.
3. Peterli R, Schuppisser JR, Herzog U, et al. Prevalence of postcholecystectomy
symptoms: long-term outcome after open versus laparoscopic cholecystectomy.
World J Surg. 2000;24:1232-1235.
4. The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic
cholecystectomies. N Engl J Med. 1991;324:1073-1078.
5. Holohan TV. Laparoscopic cholecystectomy. Lancet. 1991;338:801-803.
6. Dubois F, Berthelot G, Levard H. Laparoscopic cholecystectomy: historic perspective
and personal experience. Surg Laparosc Endosc. 1991;1:52-57.
7. Niranjan B, Chumber S, Kriplani AK. Symptomatic outcome after laparoscopic
cholecystectomy. Trop Gastroenterol. 2000;21:144-148.
8. Branum G, Schmitt C, Baillie J, et al. Management of major biliary complications
after laparoscopic cholecystectomy. Ann Surg. 1993;217:532-541.