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Post-cholecystectomy cystic duct stump leak: a preventable morbidity
Irshad Ahammed A Shaikh1, Harun Thomas, Kishore Joga
1Department of Surgery, Queen Margaret Hospital, Fife, KY12 0SU, UK. i.shaikh@nhs.net
Insights
Cystic duct stump leak (CDSL) is a common complication after laparoscopic cholecystectomy. Endoscopic management is effective, and emergency procedures show a higher CDSL incidence.
Area of Science:
- Gastroenterology
- Surgical Complications
- Biliary System Disorders
Background:
- Laparoscopic cholecystectomy is a common surgical procedure.
- Bile duct injury is a serious complication, but bile leak from the cystic duct stump is more frequent.
- This study assesses bile leakage following cholecystectomy.
Purpose of the Study:
- To evaluate the incidence and management of bile leak from the cystic duct stump (CDSL).
- To compare CDSL rates between emergency and elective laparoscopic cholecystectomies.
Main Methods:
- Retrospective analysis of 2011 cholecystectomies performed between April 2003 and March 2008.
- Data on bile leakage sourced from the Unisoft endoscopic retrograde cholangio-pancreatography (ERCP) database.
Main Results:
- Thirteen patients experienced significant bile leakage; nine had a cystic duct stump leak (CDSL).
- The overall CDSL incidence was 0.44%.
- Eight of nine CDSL patients were successfully treated with ERCP and stenting; one required percutaneous trans-hepatic cholangiography and stenting. Emergency procedures had a threefold higher CDSL rate.
Conclusions:
- The incidence of CDSL is comparable to literature reports.
- Endoscopic management is the preferred treatment for CDSL.
- Emergency laparoscopic cholecystectomies are associated with a higher risk of CDSL.
Objective:
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.
Methods:
Data related to bile leakage were obtained from the Unisoft endoscopic retrograde cholangio-pancreatography (ERCP) database.
Results:
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.
Conclusion:
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.
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