Management of biliary complications in 412 patients with liver injuries
Martijn Hommes1, Andrew J Nicol, Pradeep H Navsaria
1From the Trauma Centre (M.H., A.J.N., P.H.N., E.R.F., S.E.) and Surgical Gastroenterology: Hepatopancreaticobiliary Unit (J.E.J.K.), Department of Surgery, Groote Schuur Hospital & University of Cape Town, Cape Town, South Africa; and Department of Trauma Surgery (M.H.), Leiden University Medical Center, Leiden, the Netherlands.
Background:
Bile leaks occur in 4% to 23% of patients after major liver injuries. The role of conservative management versus internal biliary drainage has not been clearly defined. The safety and efficacy of nonoperative management of bile leaks were studied.
Methods:
Four hundred twelve patients with liver injuries were assessed in a prospective study between 2008 and 2013. All patients with clinically significant injuries to the intrahepatic biliary tract were evaluated. Bile leaks were classified as minor or major (>400 mL/d or persistent drainage >14 days). Minor leaks were managed conservatively, and major leaks underwent endoscopic retrograde cholangiogram and endoscopic biliary stenting.
Results:
Fifty-one patients (12%) developed a bile leak after liver trauma. Eleven patients (22%) with an extrahepatic duct injury underwent open surgery. Forty patients (78%) had an intrahepatic bile leak. Twenty-six patients (65%) with minor bile leaks were treated conservatively, and 14 patients (35%) with major leaks underwent endoscopic retrograde cholangiogram and internal drainage. All bile leaks resolved. There was no significant difference in the two groups with respect to septic complications (p = 0.125), intensive care unit stay (p = 0.534), hospital stay (p = 0.164), or mortality (p = 1.000).
Conclusion:
Sixty-five percent of the intrahepatic bile leaks following trauma are minor and easily managed conservatively. Endoscopic retrograde cholangiogram and internal drainage should be reserved for major leaks.
Level Of Evidence:
Therapeutic study, level IV.
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