Bikhtiyar, A., Kadhim, S. (2020). Management of Bile Leak after Laparoscopic Cholecystectomy. , 20(2), 193-199. doi: 10.52573/ipmj.2020.168629
Ali Momtaz Bikhtiyar; Sattar Jabbar Kadhim. "Management of Bile Leak after Laparoscopic Cholecystectomy". , 20, 2, 2020, 193-199. doi: 10.52573/ipmj.2020.168629
Bikhtiyar, A., Kadhim, S. (2020). 'Management of Bile Leak after Laparoscopic Cholecystectomy', , 20(2), pp. 193-199. doi: 10.52573/ipmj.2020.168629
Bikhtiyar, A., Kadhim, S. Management of Bile Leak after Laparoscopic Cholecystectomy. , 2020; 20(2): 193-199. doi: 10.52573/ipmj.2020.168629

Management of Bile Leak after Laparoscopic Cholecystectomy

Iraqi Postgraduate Medical Journal
Article 14, Volume 20, Issue 2, 2021, Pages 193-199    PDF (252.39 K)
Document Type: Research Paper
DOI: 10.52573/ipmj.2020.168629
Authors
Ali Momtaz Bikhtiyar* ; Sattar Jabbar Kadhim
Al-Yarmouk Teaching Hospital. Baghdad, Iraq
Abstract
BACKGROUND:
Bile leak after laparoscopic cholecystectomy is not an uncommon complication, it’s a serious one and its management requires a lot of resources, and expertise. The evolution of laparoscopic cholecystectomy and being the standard of management had a disadvantage of slightly elevating bile leak incidence.
OBJECTIVE:
To identify the best way management to decrease the burden on the patient either quick healing, decrease complications and outline the complications after management modalities.
PATIENTS AND METHODS:
This is a prospective study describing route of management from the period January 2018- January 2019 in Al-Yarmouk Hospital and Gastrointestinal and hepatology teaching Hospital. Where 34 patients enrolled for bile leak after laparoscopic cholecystectomy. Patients were followed from their admission, investigations, determining site of leakage, choosing the method of management according to out-put grade, site. Comparing closure time and complications related to each.
RESULTS:
The study involved 34 patients who were managed for bile leak, mean age 42.13. Females were 76.5% (26), males were 23.5% (8). ERCP and MRCP used to determine the site of leakage: cystic duct 55.9% (19), liver bed 8.8% (3) and major duct injuries: Strasberg D 32.4% (11) and Strasberg E1 2.9% (1). These sites further divided in to low-grade <300 cc/day 73.5% (25) and high-grade >300 cc/day 26.5% (9). Management was according to site and grade of leak: conservative 23.5% (8), Endoscopic Retrograde Cholangiopancreatography alone/stent 70.6% (24) and surgical reconstruction 5.9% (2).             All patients were followed for 4 months. These modalities compared to each other in terms of closure time and complications.
CONCLUSION:
Some patients with bile leak can be managed using conservative measures alone. Sphincterotomy alone can be used in low grade leaks, from cystic duct. High grade, major duct injuries is best managed with sphincterotomy plus stenting to enhance healing.
Although conservative management or sphincterotomy alone decreases the complications rate but carries a disadvantage of delaying closure time.
Sphincterotomy plus stenting enhances closure time over other methods.
 
Keywords
Bile leak; endoscopic retrograde cholangio-pancreatography sphincterotomy
References
  1. Shawhan RR, Porta CR, Bingham JR, McVay DP, Nelson DW, Causey MW, et al. Biliary leak rates after cholecystectomy and intraoperative cholangiogram in surgical residency. Military medicine. 2015 May 1;180(5):565-9.
  2. Mortensen FV, Jepsen P, Tarone RE, Funch-Jensen P, Jensen LS, Sørensen HT. Endoscopic sphincterotomy and long-term risk of cholangiocarcinoma: a population-based follow-up study. J Natl Cancer Inst. 2008; 100:745–50.
  3. Strömberg C, Luo J, Enochsson L, Arnelo U, Nilsson M. Endoscopic sphincterotomy and risk of malignancy in the bile ducts, liver, and pancreas. Clin Gastroenterol Hepatol. 2008; 6:1049–53.
  4. Mavrogiannis C, Liatsos C, Papanikolaou IS, Karagiannis S, Galanis P, Romanos A. Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study. European journal of gastroenterology & hepatology. 2006 ;18:405-9.
  5. Simmons DT, Petersen BT, Gostout CJ, Levy MJ, Topazian MD, Baron TH. Risk of pancreatitis following endoscopically placed large-bore plastic biliary stents with and without biliary sphincterotomy for management of postoperative bile leaks. Surg Endosc.2008;22:1459–63.
  6. Hall JG, Pappas TN. Current management of biliary strictures. J Gastrointest Surg. 2004; 8:1098–1110.
  7. Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006; 93:158–168.
  8. Ahrendt SA, Pitt HA. Surgical therapy of iatrogenic lesions of biliary tract. World J Surg. 2001; 25:1360–1365.
  9. Chaudhary A, Chandra A, Negi SS, Sachdev A. Reoperative surgery for postcholecystectomy bile duct injuries. Dig Surg. 2002; 19:22–27.
  10. Chun K. Recent classifications of the common bile duct injury. Korean journal of hepato-biliary-pancreatic surgery. 2014 Aug 1;18(3):69-72.
  11. Huang, Q., Yao, H. H., Shao, F., Wang, C., Hu, Y. G., Hu, S., et al. Analysis of Risk Factors for Postoperative Complication of Repair of Bile Duct Injury After Laparoscopic Cholecystectomy. Digestive Diseases and Sciences, 59(12), 3085–3091 (2014).
  12. Canena J, Horta1 D, Coimbra J, Meireles L, Russo P, Marques I, et al, Outcomes of endoscopic management of primary and refractory post cholecystectomy biliary leaks in a multicenter review of 178 patients. Department of Gastroenterology, Doutor Fernando Fonseca Hospital, IC 19, 2720-276 Amadora, Portugal,2015
  13. Chinnery G E, Bornma P C, Bernon M M, Hofmeyr S, Burmeister S, Endoscopic management of bile leaks after laparoscopic cholecystectomy, S Afr J Surg ;51(4):116-121. /SAJS.1829, Vol. 51    No. 4     November 2013 
  14. Tantia O, Jain M, Khanna S, Sen B. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. Surgical endoscopy. 2008  1;22:1077-86.
  15. Al Hajjar, C. Tomuæ, L. Mocan T. Mocan, F. Graur, C. Iancu, et al. Management of Bile Duct Injuries Following Laparoscopic Cholecystectomy: Long-term Outcome and Risk Factors Infuencing Biliary Reconstruction, Chirurgia 2014;109: 493-4;99.
  16. Sandha GS, Bourke MJ, Haber GB, Kortan PP. Endoscopic therapy for bile leak based on a new classifcation: Results in 207 patients. Gastrointest Endosc 2004;60:567-74. [http://dx.doi.org/10.1016/S0016-5107(04)01892-9.
  17. Approach to a Patient with Post Laparoscopic Cholecystectomy Bile Leak Prosanta Kumar Bhattacharjee* Department of Surgery, I.P.G.M.E and R/S.S.K.M Hospital, Kolkata, West Bengal, India.
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