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Bile leak following laparoscopic cholecystectomy
D J Azurin1, L S Go, M Maslack
1Pennsylvania Hospital, Philadelphia, USA.
Journal of Laparoendoscopic Surgery
|August 1, 1995
Summary
Symptomatic bile leaks after laparoscopic cholecystectomy are rare. Most bile leaks detected by Diisopropyl-iminodiacetic acid (DISIDA) scan are asymptomatic and clinically insignificant, requiring no intervention.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Minimally Invasive Surgery
Background:
- Bile leak is a known complication of cholecystectomy.
- Previous studies focused on open cholecystectomy.
- The incidence and significance of bile leaks after laparoscopic cholecystectomy require further investigation.
Purpose of the Study:
- To determine the incidence of postoperative bile leaks following laparoscopic cholecystectomy.
- To assess the clinical significance of these bile leaks.
- To differentiate between symptomatic and asymptomatic leaks.
Main Methods:
- Retrospective review of 1400 laparoscopic cholecystectomies (July 1990 - January 1995).
- Prospective study of 63 patients to determine the rate of asymptomatic bile leaks.
- Diisopropyl-iminodiacetic acid (DISIDA) scan used for diagnosis.
- Review of patient symptoms and interventions, including ERCP with papillotomy.
Main Results:
- Overall incidence of bile leak was low.
- In a subgroup of 63 patients, 4.7% had asymptomatic bile leaks of no clinical significance.
- In the remaining 1337 patients, the incidence of clinically significant bile leaks was 0.14% (2 patients).
- No common bile duct injuries were reported in the entire series.
Conclusions:
- Symptomatic bile leaks following laparoscopic cholecystectomy are rare.
- Asymptomatic bile leaks occur infrequently and are of no clinical significance.
- Laparoscopic cholecystectomy is a safe procedure with a low risk of significant bile leak.