Minimally invasive management of bile leak after laparoscopic cholecystectomy.
BACKGROUND
Bile leakage is an uncommon complication of cholecystectomy.The bile may originate from the gallbladder bed, the cystic duct or rarely from injury to a major bile duct.This study aims to evaluate the efficacy of minimal access endoscopic and percutaneous techniques in treating symptomatic bile leak.


METHODS
Twenty-one patients with symptomatic bile leak following laparoscopic cholecystectomy underwent assessment of the extent of the bile leak via ultrasound/CT and ERCP. Following diagnosis, the patients were treated by sphincterotomy and biliary drainage and, if necessary, percutaneous drainage of the bile collection.


RESULTS
Only one patient required primary surgical treatment following diagnosis of a major duct injury.The other 20 were treated by a combination of sphincterotomy (including a stent in most) plus percutaneous drainage in six. In 19 of 20, this minimal access approach stopped the leak.


CONCLUSIONS
Most patients who present with bile leakage after cholecystectomy can be managed successfully by means of ERCP with percutaneous drainage of any large bile collection.
Tzovaras
G
G
Hepatobiliary Unit, Department of General & Digestive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Peyser
P
P
Kow
L
L
Wilson
T
T
Padbury
R
R
Toouli
J
J