Post-cholecystectomy cystic duct stump leak: a preventable morbidity

While major bile duct injury is the most serious complication following laparoscopic cholecystectomy, bile leak from the cystic duct stump remains the commonest morbidity. This is a retrospective assessment of all patients who had a cholecystectomy over a 5-year period from April 2003 to March 2008.

Data related to bile leakage were obtained from the Unisoft endoscopic retrograde cholangio-pancreatography (ERCP) database.

Overall 2011 cholecystectomies were performed, of which 488 were done as emergency procedures. Thirteen patients had significant bile leakage, three of which were from accessory ducts, in one the source could not be identified and nine had a cystic duct stump leak (CDSL), which formed the basis of this study. Eight of the nine CDSL patients had successful ERCP and stenting. One had a percutaneous trans-hepatic cholangiography and stenting. CDSL following emergency laparoscopic cholecystectomy was up to threefold higher than after elective procedures.

The CDSL of 0.44% was comparable to the reported incidence in the literature. Endoscopic management remains the treatment of choice. Emergency cholecystectomies seem to have a higher incidence of CDSL.