Pathogenesis and treatment to postoperative bile leakage: report of 38 cases.
BACKGROUND
Bile leakage remains a serious complication after biliary surgery. The aim of this study was to assess the etiology, diagnosis and treatment of postoperative biliary leakage.


METHODS
Thirty-eight patients with biliary leakage we treated in recent 8 years were analyzed retrospectively. Among them, 8 patients had bilioenterostomy leakage, 7 accessory bile duct leakage, 7 cholecyst bed leakage, 6 leakage after removal of T-tube, 5 leakage after laparoscopic cholecystectomy, 3 leakage around T-tube, and 2 leakage caused by choledochal damage. Drainage was performed in 17 patients, reoperation in 13, drainage plus percutaneous transhepatic cholangio drainage (PTCD), endoscopic retrograde cholangiography (ERCP), endoscopic nasobiliary drainage (ENBD) and endostenting in 5, and drainage plus growth hormone in 3.


RESULTS
In this series, 37 patients were cured, and 1 died of multiple organ dysfunction syndrome (MODS). These patients were hospitalized for 2 weeks to 8 weeks. The drainage group was hospitalized shorter than the undrainage group.


CONCLUSIONS
A piece of white gauze can be used to touch surgical area in detecting biliary leakage intraoperatively. Mucous to mucous suture of the bile duct and appropriate time for removal of T-tube are recommended to prevent biliary leakage. Reoperation is essential to acute peritonitis. Drainage can be used if leakage don't diffuse or it occurs after pulling out T-tube. Drainage plus ERCP, ENBD, PTCD and drainage are effective.
Zhang
Jia-Min
JM
Jinhua Centre Hospital, Jinhua 321000, China. zhangjiamin 600323@.126.com
Yu
Shi-An
SA
Shen
Wei
W
Zheng
Zhang-Dong
ZD
D000328:Adult; D000368:Aged; D001646:Bile / Q000378:metabolism*; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000628:therapy; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013536:Suture Techniques