Features and management of bile leaks after laparoscopic cholecystectomy

Leakage of bile is one of the troublesome complications after laparoscopic cholecystectomy.

The present study reviewed our experience with this complication, in order to analyze its characteristics and proper management.

Postoperative bile leaks occurred in 23 of 1365 patients (1.7%) undergoing laparoscopic cholecystectomy from July 1990 to May 2002, with the policy of routine operative cholangiography and routine drainage of the gallbladder bed. These patients could be divided into four types. In type 1 (17 patients), bile leakage stopped spontaneously within 3 days (subclinical group). In type 2 (3 patients), the leak continued for longer than 3 days but was controlled by an endoscopic nasobiliary drainage (ENBD tube; minor-leakage group). In type 3 (2 patients), bile leakage continued for longer than 3 days and required open repair (major-leakage group). In type 4 (1 patient), bile leakage started several days after surgery (delayed-leakage group).

It is thought that better understanding of these four types of bile leakage should help in the proper management of this complication.