A Retrospective Analysis of Endoscopic Treatment Outcomes in patients with Postoperative Bile Leakage

Abstract

OBJECTIVE:Bile leakage, while rare, can be a complication seen after cholecystectomy. It may also occur after hepatic or biliary surgical procedures. Etiology may be underlying pathology or surgical complication. Endoscopic retrograde cholangiopancreatography (ERCP) can play major role in diagnosis and treatment of bile leakage. Present study was a retrospective analysis of outcomes of ERCP procedure in patients with bile leakage.METHODS:Patients who underwent ERCP for bile leakage after surgery between 2008 and 2012 were included in the study. Etiology, clinical and radiological characteristics, and endoscopic treatment outcomes were recorded and analyzed.RESULTS:Total of 31 patients (10 male, 21 female) were included in the study. ERCP was performed for bile leakage after cholecystectomy in 20 patients, after hydatid cyst operation in 10 patients, and after hepatic resection in 1 patient. Clinical signs and symptoms of bile leakage included abdominal pain, bile drainage from percutaneous drain, peritonitis, jaundice, and bilioma. Twelve (60%) patients were treated with endoscopic sphincterotomy (ES) and nasobiliary drainage (NBD) catheter, 7 patients (35%) were treated with ES and biliary stent (BS), and 1 patient (5%) was treated with ES alone. Treatment efficiency was 100% in bile leakage cases after cholecystectomy. Ten (32%) cases of hydatid cyst surgery had subsequent cystobiliary fistula. Of these patients, 7 were treated with ES and NBD, 2 were treated with ES and BS, and 1 patient (8%) with ES alone. Treatment was successful in 90% of these cases.CONCLUSION:ERCP is an effective method to diagnose and treat bile leakage. Endoscopic treatment of postoperative bile leakage should be individualized based on etiological and other factors, such as accompanying fistula.

Intrahepatic biloma after intraoperative cholangiography

“…There are known risk factors for iatrogenic biliary injuries. Obesity, previous biliary surgery, anatomical variations, an elevation in intraductal pressure (due to lithiasis) and inflammatory lesions of the epithelium can induce fragility in the biliary tree and lead to rupture 5 6…”

Të jesh Imam në epokën digjitale

“…27 Madje në të ardhmen e afërt do të jetë ndër problemet e para shëndetësore. 28 Ndaj, ndër rolet më me rëndësi të imamit në shekullin e fundit, do të jetë ofrimi i ndihmës shpirtërore për njeriun e sotëm aq të stresuar. Shqetësimet shpirtërore ende janë tabu në shoqërinë tonë kur bëhet fjalë për pranimin e tyre si problem psikik.…”

“…Padyshim që nuk kemi receta magjike për këtë, por ajo që OPINION Univers është në duart tona është që të kemi pak disiplinë, të kuptojmë identitetin digjital dhe të vetëdijesohemi për këtë epokë. 33 Asnjë sfidë nuk është e patejkalueshme. Njeriu është i krijuar me natyrë që mund të përshtatet me çdo lloj kushti.…”

A retrospective clinical and microbial analysis of 32 patients with bilomas

“…The alkaline characteristic of bile triggers inflammation in the surrounding parenchyma leading to adhesion and demarcation of the biliary collection [3]. Genesis of biloma are mainly iatrogenic injury of the bile duct system [4], whereas spontaneous bilomas are very rare and mostly associated to choledocholithiasis [5]. Surgical interventions like cholecystectomy or liver transplantation are the most common cause of bilomas [4].…”

“…Genesis of biloma are mainly iatrogenic injury of the bile duct system [4], whereas spontaneous bilomas are very rare and mostly associated to choledocholithiasis [5]. Surgical interventions like cholecystectomy or liver transplantation are the most common cause of bilomas [4]. In case of infection, the differentiation of bilomas from liver abscesses is challenging, although abscesses are less caused by interventions and tend to be more encapsulated compared to bilomas [6].…”