A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation.
BACKGROUND
Bilomas are localized collections of bile occurring usually post-operatively from an injured cystic or bile duct. Our study aims to evaluate the efficacy of minimal access endoscopic and percutaneous modalities in treating symptomatic bile leak and biloma formation.


METHODS
Sixteen patients with biloma after open or laparoscopic cholecystectomy underwent assessment of the site and extent of the bile leak via endoscopic retrograde cholangiography (ERC). Endoscopic sphincterotomy was performed in all patients who were managed non-operatively, any retained duct stones were removed, and an endoprosthesis was inserted in a selected basis. Percutaneous drainage of the bile collection, under ultrasound or computed tomography guidance, followed ERC.


RESULTS
ERC supplemented by computed tomography or ultrasound guided percutaneous biloma drainage was successful in 15 patients. One patient having major ductal injury was treated surgically. Thirteen patients had leakage from the cystic duct, one from the right hepatic duct, and one from an aberrant right hepatic duct. Bile duct stones were removed from seven patients an endoprosthesis was inserted in six and a nasobilary catheter in one. Bilomas resolved and bile leakage was treated successfully in all 15 patients with no further complications.


CONCLUSIONS
ERC accurately diagnoses the cause of postcholecystectomy bile leakage and biloma formation. Furthermore, endoscopic sphincterotomy and selective stent insertion in coordination with percutaneous drainage procedures represents in the majority of cases the corner stone of a definitive treatment.
Christoforidis
Emmanuel
E
Fourth Surgical Clinic of Aristotle University of Thessaloniki, Thessaloniki, Greece.
Vasiliadis
Konstantinos
K
Goulimaris
Ioannis
I
Tsalis
Konstantinos
K
Kanellos
Ioannis
I
Papachilea
Tea
T
Tsorlini
Eleni
E
Betsis
Dimitrios
D
D000328:Adult; D000368:Aged; D001646:Bile; D001660:Biliary Tract Diseases / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed