Leaks from laparoscopic cholecystectomy

Hepatogastroenterology. 2002 Jul-Aug;49(46):924-5.


Background/aims: Significant postoperative bile leaks occur in approximately 1% of patients. The goal of endoscopic therapy is to eliminate the transpapillary pressure gradient, thereby permitting preferential transpapillary bile flow rather than extravasation at the site of leak.

Methodology: Sixty-four patients were retrospectively evaluated. Endoscopic treatment comprised endoscopic sphincterotomy followed by insertion of a naso-biliary drainage or a stent. Retained stones were extracted by standard procedures.

Results: The site of bile extravasation was the cystic duct in 50 cases, ducts of Luschka in 4 cases, common bile duct in 6 cases and common hepatic duct in 4 cases. Retained bile duct stones were detected in 21 cases and papillary stenosis in 4 cases. Endoscopic sphincterotomy was performed in 25 cases, with stones extraction and nasobiliary drainage in 21 cases, and placement of stent in the remainder. Bile leaks resolved in 96.9% of patients, after endoscopic procedure. Two cases of mild pancreatitis were evidenced from endoscopic treatment.

Conclusions: Endoscopic management is the treatment of choice of postcholecystectomy bile leaks.

MeSH terms

  • Adult
  • Aged
  • Biliary Fistula / etiology*
  • Cholecystectomy, Laparoscopic / adverse effects*
  • Drainage
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Postcholecystectomy Syndrome / etiology*
  • Postcholecystectomy Syndrome / therapy
  • Retrospective Studies
  • Risk Factors
  • Sphincterotomy, Endoscopic
  • Stents