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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Born
P
P
Medizinische Klinik, Technische Universität München.
Brühl
K
K
Rösch
T
T
Ungeheuer
A
A
Neuhaus
H
H
Classen
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D016896:Treatment Outcome