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Role of Symptoms, Trend of Liver Tests, and Endotherapy in Management of Post-Cholecystectomy Biliary Leak

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Abstract

Aim

Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak.

Materials and Methods

Twenty-one patients (8 M, 26–77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients.

Results

Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n = 10), accessory duct (n = 4), or cystic duct stump (n = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n = 8), stone (n = 2), or cholangiocarcinoma (n = 1) and underwent stenting (n = 4), naso-biliary drainage, NBD (n = 3), or surgery (n = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic.

Conclusions

Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

LTs:

Liver tests

NBD:

Naso-biliary drainage

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Authors and Affiliations

  1. Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    P. Cantù, A. Tenca, C. Caparello, A. Grigolon, L. Piodi, I. Bravi, D. Conte & R. Penagini

  2. Department of Emergency Surgery, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    E. Contessini Avesani

  3. General Medicine Unit, C. Cantu’ Hospital, University of Milan, AO Legnano, Piazza Mussi 1, 20081, Abbiategrasso, Milan, Italy

    P. Cantù

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  1. P. Cantù
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  2. A. Tenca
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Cantù, P., Tenca, A., Caparello, C. et al. Role of Symptoms, Trend of Liver Tests, and Endotherapy in Management of Post-Cholecystectomy Biliary Leak. Dig Dis Sci 56, 1565–1571 (2011). https://doi.org/10.1007/s10620-010-1448-2

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  • DOI: https://doi.org/10.1007/s10620-010-1448-2

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