Leaks from laparoscopic cholecystectomy.
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.
De Palma
Giovanni D
GD
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
Galloro
Giuseppe
G
Iuliano
Gianpaolo
G
Puzziello
Alessandro
A
Persico
Francesco
F
Masone
Stefania
S
Persico
Giovanni
G
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