Post-laparoscopic cholecystectomy bilomas--preliminary experience

The incidence of biloma formation after laparoscopic cholecystectomy (LC) is, in the early experience of many centres, significantly higher than after open cholecystectomy. We describe four cases representative of the possible spectrum of post-LC bile leaks and review the literature regarding the radiologic investigation and management of this complication. We suggest that post-LC bilomas should initially be drained percutaneously. Endoscopic cholangiography (ERC) should then be used to identify the source of the leak, but sphincterotomy and/or stent placement may be best reserved for those whose leaks do not resolve after 10 days of free drainage. Surgery is recommended only for major biliary injury and for leaks that remain unresolved after sphincterotomy and/or stenting. An algorithmic summary of this approach is presented.