title: Management of patients who return to the hospital with a bile leak after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Bile leaks after laparoscopic cholecystectomy (LC) can be difficult to diagnose early. The aim of this study was to investigate the clinical features of minor bile leaks and to discuss how to manage patients who revisit the hospital with minor bile leaks after LC.
  
  
  METHODS
  From January 2001 to September 2007, 2219 LCs were performed at the Ajou University Medical Center. Twenty-four patients (1.0%) who presented with a bile leak or bile duct injury after a cholecystectomy were identified. The patients with minor bile duct injury were divided into two groups, depending on whether they revisited the hospital (group 2) or not (group 1) after LC.
  
  
  RESULTS
  Seventeen of 24 patients had minor bile leaks. The characteristics of patients in group 2 were long hospital stay, short operation time, and low frequency of indwelling surgical drains. Ten of 17 patients (58.8%) revisited the hospital at a mean of 7.0 +/- 2.7 days after the LC. However, 3 of 10 patients (30%) were discharged from the ER with atypical abdominal pain and returned to the hospital again within 5 days due to recurrent abdominal pain. There was a significant correlation between hospital stay and time to endoscopic retrograde cholangiopancreatography (ERCP) (P = 0.008) and between hospital stay and PCD (P = 0.028).
  
  
  CONCLUSIONS
  Most minor bile leaks were managed by ERCP and/or percutaneous drainage. However, early diagnosis was difficult when patients revisited the hospital within 7 days after the LC. Therefore, early ERCP should be considered in these patients to diagnose the bile leak early and limit needed hospital stay.
authors.affiliation: Department of Surgery, School of Medicine, Ajou University , Suwon, Korea.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Kim
authors.forename: Wook Hwan
authors.initials: WH
authors.lastname: Kim
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Byung Moo
authors.initials: BM
authors.lastname: Yoo
authors.forename: Myung Wook
authors.initials: MW
authors.lastname: Kim
mesh_terms: D000328:Adult; D001646:Bile; D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult