Nasobiliary drainage for biliary leaks after laparoscopic cholecystectomy

The optimal endoscopic procedure and the appropriate duration of treatment in management of patients with biliary leaks after laparoscopic cholecystectomy (LC) have not been established so far. The aim of the study is the evaluation of endoscopic drainage by endoscopic sphincterotomy (ES) and/or nasobiliary tube placement in treatment of biliary leaks after LC.

ERCP identified a biliary fistula site after LC in 17 patients as arising from the cystic duct stump (n = 12), anomalous branch of right hepatic duct (n = 1) and common bile duct (n = 4). The mean time from LC to referral was 7.5 days. Therapy consisted of insertion of 7F-nasobiliary tube without ES in 13 patients and with ES in 4 patients. ES was performed only in cases of common bile duct injury. Nasobiliary tubes were used in all patients because this allowed for frequent contrast examinations in order to monitor efficacy of therapy and to determine the exact duration of treatment required.

Nasobiliary tube placement alone was effective for the treatment of biliary leaks after LC in all patients, except 4 patients with common bile duct injury. Nasobiliary tube alone is not as effective for drainage of this part of the biliary tree as the combination of ES with nasobiliary tube. All leaks closed within 1 week, except for four patients with common duct leaks in whom 2 weeks were required for closure of the fistula.

Nasobiliary tube placement is effective in healing biliary leaks after LC. I prefer to avoid ES because of its procedure-related risk. ES was performed only in cases of common bile duct injury in order to reduce the resistance to normal bile to a minimum.