title: Leaks from laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Significant postoperative bile leaks occur in approximately 1% of patients. The goal of endoscopic therapy is to eliminate the transpapillary pressure gradient, thereby permitting preferential transpapillary bile flow rather than extravasation at the site of leak.
  
  
  METHODS
  Sixty-four patients were retrospectively evaluated. Endoscopic treatment comprised endoscopic sphincterotomy followed by insertion of a naso-biliary drainage or a stent. Retained stones were extracted by standard procedures.
  
  
  RESULTS
  The site of bile extravasation was the cystic duct in 50 cases, ducts of Luschka in 4 cases, common bile duct in 6 cases and common hepatic duct in 4 cases. Retained bile duct stones were detected in 21 cases and papillary stenosis in 4 cases. Endoscopic sphincterotomy was performed in 25 cases, with stones extraction and nasobiliary drainage in 21 cases, and placement of stent in the remainder. Bile leaks resolved in 96.9% of patients, after endoscopic procedure. Two cases of mild pancreatitis were evidenced from endoscopic treatment.
  
  
  CONCLUSIONS
  Endoscopic management is the treatment of choice of postcholecystectomy bile leaks.
authors.affiliation: Department of Surgery and Advanced Technologies, Division of General Surgery, Service of Digestive Endoscopy, University of Naples Federico II, School of Medicine, Naples, Italy. gdepalma@arrotino.it
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: De Palma
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galloro
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Iuliano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Puzziello
authors.forename: Francesco
authors.initials: F
authors.lastname: Persico
authors.forename: Stefania
authors.initials: S
authors.lastname: Masone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Persico
mesh_terms: D000328:Adult; D000368:Aged; D001658:Biliary Fistula / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D015607:Stents