title: Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management. McGill Gallstone Treatment Group.
abstract: BACKGROUND
  The management of bile leaks has evolved in the laparoscopic era. This study characterizes risk factors for their developmental and their clinical course and management.
  
  
  METHODS
  Data on a cohort of patients who developed bile leaks after cholecystectomy in the laparoscopic era were gathered prospectively and retrospectively from an ongoing surgical database and following a review of hospital charts.
  
  
  RESULTS
  Sixty-four patients (mean age 56 +/- 17.1 years, 72% women) were included over a 5-year study period. The incidence of leaks was 1.1% among patients entered in a laparoscopic cholecystectomy database. Intraoperative complications were encountered in 36%. Rates of intraoperative complication and conversion to open surgery were greater among patients who developed leaks (5.2% vs 0.6% and 33% vs 6.3%, respectively, p < 0.00001). Patients presented 5.3 +/- 4.2 days following surgery with abdominal pain (89%), fever (74%), and tenderness (81%). Ultrasound diagnosed a suspected leak in 73%, which ERCP showed as originating from the cystic duct stump in 77%. Biliary obstruction was noted in 20 (31%) patients (14 with stones). Treatments included percutaneous (13%), endoscopic (28%), primary or secondary operative procedures (14%), or a combination thereof (45%).
  
  
  CONCLUSIONS
  A complication at laparoscopic cholecystectomy increases the likelihood of a subsequent bile leak. Most patients present early with a patent cystic duct stump in the absence of biliary obstruction. Endoscopic therapy is successful in the majority of cases, but otherwise percutaneous or operative procedures may be needed.
authors.affiliation: Division of Gastroenterology, Montreal General Hospital, McGill University, Montreal, Québec, Canada.
authors.forename: A N
authors.initials: AN
authors.lastname: Barkun
authors.forename: M
authors.initials: M
authors.lastname: Rezieg
authors.forename: S N
authors.initials: SN
authors.lastname: Mehta
authors.forename: E
authors.initials: E
authors.lastname: Pavone
authors.forename: S
authors.initials: S
authors.lastname: Landry
authors.forename: J S
authors.initials: JS
authors.lastname: Barkun
authors.forename: G M
authors.initials: GM
authors.lastname: Fried
authors.forename: P
authors.initials: P
authors.lastname: Bret
authors.forename: A
authors.initials: A
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003287:Contrast Media; D003549:Cystic Duct / Q000293:injuries*; D004322:Drainage; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery; D006801:Humans; D007098:Imino Acids; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007098:Imino Acids; C049470:lidofenin