Leaks from laparoscopic cholecystectomy
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Giovanni D De Palma1, Giuseppe Galloro, Gianpaolo Iuliano
1Department of Surgery and Advanced Technologies, Division of General Surgery, Service of Digestive Endoscopy, University of Naples Federico II, School of Medicine, Naples, Italy. gdepalma@arrotino.it
Background/Aims:
Significant postoperative bile leaks occur in approximately 1% of patients. The goal of endoscopic therapy is to eliminate the transpapillary pressure gradient, thereby permitting preferential transpapillary bile flow rather than extravasation at the site of leak.
Methodology:
Sixty-four patients were retrospectively evaluated. Endoscopic treatment comprised endoscopic sphincterotomy followed by insertion of a naso-biliary drainage or a stent. Retained stones were extracted by standard procedures.
Results:
The site of bile extravasation was the cystic duct in 50 cases, ducts of Luschka in 4 cases, common bile duct in 6 cases and common hepatic duct in 4 cases. Retained bile duct stones were detected in 21 cases and papillary stenosis in 4 cases. Endoscopic sphincterotomy was performed in 25 cases, with stones extraction and nasobiliary drainage in 21 cases, and placement of stent in the remainder. Bile leaks resolved in 96.9% of patients, after endoscopic procedure. Two cases of mild pancreatitis were evidenced from endoscopic treatment.
Conclusions:
Endoscopic management is the treatment of choice of postcholecystectomy bile leaks.
