Management of bile leakage after laparoscopic cholecystectomy based on etiological classification.
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.
Lien
Heng-Hui
HH
Department of Surgery, Cathay Medical Center, Taipei, Taiwan.
Huang
Ching-Shui
CS
Shi
Min-Yen
MY
Chen
Der-Fang
DF
Wang
Nai-Yuan
NY
Tai
Feng-Chuan
FC
Chen
Shu-Hung
SH
Lai
Ching-Yuan
CY
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