title: Management of bile leakage after laparoscopic cholecystectomy based on etiological classification.
abstract: OBJECTIVE
  To analyze and classify bile leakage after laparoscopic cholecystectomy (LC) according to its etiology. This classification will help to determine the most appropriate management strategy, whereby unnecessary intervention can be avoided.
  
  
  METHODS
  We examined the medical records of 16 patients in whom bile leakage occurred as a complication of LC.
  
  
  RESULTS
  Bile leakage was classified according to its cause into the following groups: insecure closure of the cystic duct stump (n = 3); retention of a common bile duct (CBD) stone (n = 1); CBD injury (n = 10); unsuspected accessory bile ducts (n = 1); and unknown origin (n = 1). The management strategies included observation (n = 3), laparoscopic intervention with drainage (n = 4), laparotomy with drainage (n = 3), and laparotomy with Roux-en-Y choledochojejunostomy for CBD transection (n = 6). All 16 patients recovered uneventfully with similar hospitalization.
  
  
  CONCLUSIONS
  Bile leakage is not always caused by bile duct injury, and it would be inappropriate to attribute leakage to bile duct injury if there is a retained CBD stone, an unsuspected accessory duct, or an unsecured cystic duct stump. Thus, the management of each condition should vary accordingly. Reviewing a videotape of the surgery and early cholangiogram can help to establish the etiological diagnosis and select the most appropriate course of action.
authors.affiliation: Department of Surgery, Cathay Medical Center, Taipei, Taiwan.
authors.forename: Heng-Hui
authors.initials: HH
authors.lastname: Lien
authors.forename: Ching-Shui
authors.initials: CS
authors.lastname: Huang
authors.forename: Min-Yen
authors.initials: MY
authors.lastname: Shi
authors.forename: Der-Fang
authors.initials: DF
authors.lastname: Chen
authors.forename: Nai-Yuan
authors.initials: NY
authors.lastname: Wang
authors.forename: Feng-Chuan
authors.initials: FC
authors.lastname: Tai
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Chen
authors.forename: Ching-Yuan
authors.initials: CY
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D001646:Bile; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged