Bile leakage after laparoscopic cholecystectomy: biliary anatomy revisited

Bile leakage from the gall-bladder bed following laparoscopic cholecystectomy is recognized as a potential cause of major morbidity. This problem is usually attributed to division of ducts draining a portion of liver directly into the gall-bladder. The authors' experience, however, and a review of the literature suggests that injury to a superficial duct draining into the major hepatic ducts rather than the gall-bladder is the principal cause of this problem. Three patients with bile leakage demonstrated on postoperative biliary tract imaging are presented with a discussion of the literature.