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Surgery in perforation after endoscopic sphincterotomy: sooner, later or not at all?

During a period of 8 years we managed ten patients with perforations resulting from endoscopic sphincterotomy. Four patients underwent operation within 24 h of the perforation, while six underwent operation later than 24 h. All the deaths and complications occurred in the latter group. Our experience underscores the importance of early diagnosis of perforation after endoscopic sphincterotomy and supports an aggressive surgical approach.