Long-term follow-up of endoscopic therapy in patients with post-surgical biliary leakage

Leakage is a rare complication of biliary surgery which is thought to follow a benign course after appropriate treatment. However there is a paucity of long-term follow-up data.

In this retrospective analysis, we present our experience with 21 patients in whom a biliary leakage was diagnosed following conventional and laparoscopic cholecystectomy (n = 14) or other types of biliary surgeries such as liver transplantation or segmental liver resection. Long-term follow-up (mean: 15.5 months) was obtained by telephone contact with patients, families or referring physicians.

Endoscopic therapy was primarily successful in 20 of 21 patients and failed in 1 case with complete common bile duct dissection. Closure of the leakage was achieved by placement of nasobiliary tubes or endoprostheses with (n = 16) or without (n = 4) endoscopic papillotomy. Despite successful endoscopic therapy 3 patients died, 1 unrelated to the intervention, and 2 due to prolonged biliary sepsis (mortality: 9.5%; 30 day: 4.8%). Long-term follow-up in the surviving 18 patients showed them to be free of biliary complaints.

ERCP is the primary modality to diagnose and treat post-operative biliary leakages. Despite rapid healing of the leakage in all 20 successfully treated cases, complications-related mortality was higher than previously suspected.