Abstract
Background
Bile leakage after laparoscopic biliary surgery is a surgical challenge in which endoscopy can play an important role.
Methods
A total of 26 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) in our department. Patients with evidence of major ductal injury were treated surgically. In all other cases, endoscopic sphincterotomy was performed, any retained bile duct stones were removed, and a biliary endoprosthesis or a nasobiliary catheter was inserted on a selective basis.
Results
ERCP was successful in 24 patients. Seven patients were treated surgically after cholangiography revealed major ductal injury. Two more patients were eventually operated on due to bile peritonitis. Of the other 15 patients, 11 had leakage from the cystic duct and four had leakage from the gallbladder bed. Bile duct stones were removed from eight patients, an endoprosthesis were inserted in five patients, and a nasobiliary catheter was inserted in two patients. Bile leakage was treated successfully in all 15 patients with no further complications.
Conclusion
ERCP is a means of safe diagnosing the cause of a bile leakage and offers a definitive treatment in most cases.
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References
Airan M, Appel M, Berci G, Coburg AJ, Cohen M, Cuschieri A, Dent T, Duppler D, Easter D, Greene F (1992) Retrospective and prospective multi-institutional laparoscopic cholecystectomy study organized by the Society of American Gastrointestinal Endoscopic Surgeons. Surg Endosc 6: 169–176
Benson EA (1981) Is ischaemia a possible factor in the aetiology of bile duct stricture? Br J Clin Prac 35: 97–104
De Backer A, Fierens H, De Schepper A, Pelckmans P, Josens PG, Vaneerderweg W (1998) Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases. Eur Radiol 8: 1619–1622
Del Olmo L, Merono E, Moreira VF, Garcia T, Garcia-Plaza A (1988) Successful treatment of postoperative external biliary fistulas by endoscopic sphincterotomy. Gastrointest Endosc 34: 307–309
Elboim CM, Goldman L, Hann L, Palestrant AM, Silen W (1983) Significance of post-cholecystectomy subhepatic fluid collections. Ann Surg 198: 137–141
Foutch PG, Harlan JR, Hoefer M (1993) Endoscopic therapy for patients with a post-operative biliary leak. Gastrointest Endosc 39: 416–421
Gholson CF, Burton F (1992) Closure of a controlled biliary fistula complicating partial cholecystectomy with endoscopic biliary stenting. Am J Gastroenterol 87: 248–251
Hanazaki K, Igarashi J, Sodeyama H, Matsuda Y (1999) Bile leakage resulting from clip displacement of the cystic duct stump: a potential pitfall of laparoscopic cholecystectomy. Surg Endosc 13: 168–171
Jenkins MA, Ponsky JL, Lehman GA, Fanelli R, Bianchi T (1994) Treatment of bile leaks from the cystohepatic ducts after laparoscopic cholecystectomy. Surg Endosc 8: 193–196
Kozarek RA (1994) Endoscopic techniques in management of biliary tract injuries. Surg Clin North Am 74: 883–894
Larson GM, Vitale GC, Casey J, Evans JS, Gilliam G, Heuser L, McGee G, Rao M, Scherm MJ, Voyles CR (1992) Multipractice analysis of laparoscopic cholecystectomy in 1, 983 patients. Am J Surg 163: 221–226
Liguory C, Vitale GC, Lefebvre JF, Bonnel D, Cornud F (1991) Endoscopic treatment of postoperative biliary fistulas. Surgery 110: 779–784
Lorenzini I, Freddara V, Mosca P, Galeazzi R (1995) Endoscopic treatment of postoperative biliary leak without sphincterotomy [Abstract]. Gastroenterology 108: A425
Odell RC (1993) Laparoscopic electrosurgery. In: Hunter JG, Sackier JM (eds) Minimally invasive surgery. McGraw-Hill, New York, pp 33–42
Prat F, Pelletier G, Ponchon T, Fritsch J, Meduri B, Boyer J, Person B, Bretagne JF (1997) What role can endoscopy play in the management of biliary complications after laparoscopic cholecystectomy? Endoscopy 29: 341–348
Regoly-Merel J, Ihasz M, Sreberin Z, Sandor J, Mate M (1998) Biliary tract complications in laparoscopic cholecystectomy: a multicenter study of 148 biliary tract injuries in 26440 operations. Surg Endosc 12: 294–300
Van Sonnenberg E, D’Agostino HB, Easter DW, Sanchez RB, Christensen RA, Kerlan RK Jr, Moossa AR (1993) Complications of laparoscopic cholecystectomy: coordinated radiologic and surgical management in 21 patients. Radiology 188: 399–404
Wills VL, Jorgrnsen JO, Hunt DR, (2000) Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy. Br J Surg 87: 176–180
Woods MS, Shellito JL, Santoscoy GS, Hagan RC, Kilgore WR, Traverso LW, Kozarek RA, Brandabur JJ (1994) Cystic duct leaks in laparoscopic cholecystectomy. Am J Surg 168: 560–565
Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D, Donohue JH (1994) Characteristics of biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study. Am J Surg 167: 27–32
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Online publication: 8 February 2002
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Christoforidis, E., Goulimaris, I., Tsalis, K. et al. The endoscopic management of persistent bile leakage after laparoscopic cholecystectomy. Surg Endosc 16, 843–846 (2002). https://doi.org/10.1007/s00464-001-9091-9
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DOI: https://doi.org/10.1007/s00464-001-9091-9