Minimally invasive management of bile leak after laparoscopic cholecystectomy

Abstract

Most patients who present with bile leakage after cholecystectomy can be managed successfully by means of ERCP with percutaneous drainage of any large bile collection.

A Single Center Experience in Minimally Invasive Treatment of Postcholecystectomy Bile Leak, Complicated With Biloma Formation

“…Bile leak and biloma formation after cholecystectomy may arise from three sources: the cystic duct, a subresical bile duct (duct of Luschka) or a bile duct injury [5,14]. Bile leaks have been reported more commonly after laparoscopic than open cholecystectomy [15].…”

“…Stent placement is a more controversial procedure [5,6,18,20]. The insertion of a stent after endoscopic sphincterotomy (ES) is not always advisable [21].…”

“…It is estimated that biloma originates from the cystic duct in more than 50% of the cases [2]. In addition several series have reported bile leakage rates of 1.2 to 4% after laparoscopic cholecystectomy that is higher than the incidence in open cholecystectomy [3][4][5].…”

Biliary Leaks and Thoracobiliary Fistula

“…The cystic duct stump, ducts of Luschka, other ducts in the gallbladder fossa, and major extrahepatic bile ducts comprise the potential sites of biliary leakage. The cystic duct stump represents the most common site of leak and reported risk factors include emergency surgery, incomplete or disrupted closure of the cystic duct, width and degree of inflammation of the cystic duct, and presence of common bile duct stones [5,6]. The risk factors for biliary leaks related to major bile duct injury and classification of biliary injury following cholecystectomy have been reported previously and a complete discussion is beyond the scope of this chapter [7].…”

Stents in Gastrointestinal Endoscopy

“…Biliary leaks usually become evident in the early post-operative period, and may arise from an inadvertent intraoperative bile duct injury, or from the clips on the transected cystic duct becoming displaced. Once it is evident that a biliary leak with consequent biliary peritonitis is occurring, endoscopic treatment at ERCP is the preferred intervention (Tzovaras et al, 2001;Sandha et al, 2004;Agarwal et al, 2006). Endoscopic sphincterotomy alone will reduce pressure in the biliary system by equating it with intraduodenal pressure.…”