Role of symptoms, trend of liver tests, and endotherapy in management of post-cholecystectomy biliary leak.
OBJECTIVE
Biliary leaks are widely reported complications of cholecystectomy, but standard management remains undecided. The objective of our study was to report the role of symptoms, biochemical tests, and ERCP in patients with a leak.


METHODS
Twenty-one patients (8 M, 26-77 years) with suspected post-cholecystectomy biliary leak were retrospectively studied. Symptoms and liver tests (LTs) after surgery were monitored. Trends of LTs were considered positive if increases at >48 h were seen. ERCP was performed in all patients. Findings at endoscopy and treatments were reported. Outcome results were obtained for all patients.


RESULTS
Seventeen of 21 patients had persistent biliary leak at ERCP, because of direct injury (n = 10), accessory duct (n = 4), or cystic duct stump (n = 3). Eleven of 17 patients (six without symptoms), had distal obstruction because of surgical injury (n = 8), stone (n = 2), or cholangiocarcinoma (n = 1) and underwent stenting (n = 4), naso-biliary drainage, NBD (n = 3), or surgery (n = 4). Among the six patients without obstruction (four without symptoms), stenting was performed in two and NBD in four. The four patients without apparent leak underwent NBD. Impairment of LTs was present in ten out of eleven (91%) patients with obstruction versus six of ten (60%) without obstruction. No complications occurred after ERCP. During a median follow-up of 33 months (cholangiocarcinoma excluded) all but one remained asymptomatic.


CONCLUSIONS
Symptoms and trend of LTs were not predictive of biliary obstruction in patients with a leak after cholecystectomy. Both endotherapy and surgery had favorable outcomes.
Gastrointestinal Unit 2, Fondazione IRCCS, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. paolo.cantu@ao-legnano.it
P
P
Cantù
A
A
Tenca
C
C
Caparello
A
A
Grigolon
L
L
Piodi
I
I
Bravi
E Contessini
EC
Avesani
D
D
Conte
R
R
Penagini
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies