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Bile leakage following laparoscopic cholecystectomy

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Abstract

Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstones, but there has been concern that bile leakage with LC is more frequent than after open cholecystectomy (OC). We have analyzed our experience of this complication with regard to both its incidence and management.

From a consecutive series of 500 LC, in which both operative cholangiography and drainage of the gallbladder bed were routine, bile leakage was identified in ten patients (2%). There was no bile duct injury. Nine of the ten patients presented with bile in the drain within 24 h of operation and one patient presented 1 week after operation with a subphrenic collection. Of the ten patients, five settled spontaneously. Of the five remaining patients, two needed laparotomy—one for a subphrenic collection not responding to percutaneous drainage and one for biliary peritonitis. One patient was treated by relaparoscopy and suture of a duct of Luschka and one patient had successful percutaneous drainage of an infected collection; the fifth patient who presented with a late subphrenic collection of bile was shown at endoscopic retrograde cholangiopancreatography (ERCP) to have a cystic duct stump leak and was treated with an endoscopic stent.

Bile leakage is seen more frequently after LC than OC for reasons that are currently unclear. We believe that the use of routine gallbladder bed drainage is justified for this reason alone. The majority of bile leaks settle either spontaneously or with minimally invasive intervention.

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References

  1. Adams DB, Borowicz MR, Wootton FT, Cunningham JT (1993) Bile duct complications after laparoscopic cholecystectomy. Surg Endosc 7: 79–83

    Google Scholar 

  2. Barthel JS, Sastri SV, Landsbaum C (1989) Closure of cystic duct stump leak by nasobiliary tube drainage. J Clin Gastroenterol 86: 227–231

    Google Scholar 

  3. Branum G, Schmitt C, Baillie J, Suhocki P, Baker M, Davidoff A, Branch S, Chart R, Cucchiaro G, Murray E, Pappas T, Cotton P, Meyers C (1993) Management of major biliary complications after laparoscopic cholecystectomy. Ann Surg 217: 532–541

    Google Scholar 

  4. Brooks DC, Becker JM, Connors PI, Carr-loke DL (1993) Management of bile leaks following laparoscopic cholecystectomy. Surg Endosc 7: 292–295

    Google Scholar 

  5. Brough WA, Hennessy O, Ewing H, Kune GA (1988) Percutaneous drainage of subphrenic biliary collections using a Ring-McLean sump catheter. Aust N Z J Surg 58: 579–581

    Google Scholar 

  6. Cushieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidi H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387

    Google Scholar 

  7. Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, Newman GE, Cotton PB, Meyers WC (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215: 196–202

    Google Scholar 

  8. Dion YM, Morin J (1990) Laparoscopic cholecystectomy: a report of 60 cases. Can J Surg 33: 483–486

    Google Scholar 

  9. Estrada WN, Zanzi I, Ward R, Negrin JA, Margouleff D (1991) Scintigraphic evaluation of postoperative complications of laparoscopic cholecystectomy. J Nucl Med 32: 1910–1911

    Google Scholar 

  10. Gadacz TR, Talamini MA, Lillemoe KD, Yeo CJ (1990) Laparoscopic cholecystectomy. Surg Clin North Am 70: 1249–1263

    Google Scholar 

  11. Gelman R, Alexander MS, Zucker KA, Bailey RW (1991) The use of radionuclide imaging in the evaluation of suspected biliary damage during laparoscopic cholecystectomy. Gastrointest Radiol 16: 201–204

    Google Scholar 

  12. Gilsdorf JR, Phillips M, McLeod MK, Harness JK, Hoverstein GH, Woodbury D, Daley K (1986) Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy. Am J Surg 151: 259–262

    Google Scholar 

  13. Gould L, Patel A (1970) Ultrasound detection of extrahepatic encapsulated bile: “biloma.” A J R Am J Roentgenol 132: 1014–1015

    Google Scholar 

  14. Hawasli A (1992) To drain or not to drain in laparoscopic cholecystectomy: rationale and technique. Surg Laparosc Endosc 2: 128–130

    Google Scholar 

  15. Janardhanan R, Brodmerkel GJ, Turowkski P, Gregory DH, Agrawal RM (1986) Endoscopic retrograde cholangiopancreatography in the diagnosis and management of postcholecystectomy cystic duct leaks. Am J Gastroenterol 81: 474–476

    Google Scholar 

  16. Kaufman SL, Kadir S, Mitchell SE, Chang R, Kinnison ML, Cameron JL, White RI (1985) Percutaneous transhepatic biliary drainage for bile leaks and fistulas. A J R Am J Roentgenol 144: 1055–1058

    Google Scholar 

  17. Klotz HP, Schlumpf R, Largiader F (1992) Injury to an accessory bile duct during laparoscopic cholecystectomy. Surg Lap Endosc 2: 317–320

    Google Scholar 

  18. Kozareck RA, Traverso LW (1991) Endoscopy stent placement for cystic duct leak after laparoscopic cholecystectomy. Gastrointest Endosc 37: 71–74

    Google Scholar 

  19. Kozarek R, Gannan R, Baerg R, Wagonfeld J, Ball T (1992) Bile leak after laparoscopic cholecystectomy. Arch Intern Med 152: 1040–1043

    Google Scholar 

  20. Kuligowska E, Schlesinger A, Miller KB, Lee VW, Grosso D (1983) Bilomas: a new approach to the diagnosis and treatment. Gastrointest Radiol 8: 237–243

    Google Scholar 

  21. Martin IG, Dexter SPL, Marton J, Gibson J, Asker J, McMahon MJ (1995) Fundus first laparoscopic cholecystectomy. Surg Endosc (in press)

  22. Martin IG, Holdsworth PJ, Asker J, Baltas B, Glinatsis MT, Sue-Ling D, McMahon M (1992) Laparoscopic cholecystectomy as a routine procedure for gallstones: results of an “all comers” policy. Br J Surg 79: 807–810

    Google Scholar 

  23. McAney DB, Gibran NS, Braasch JW (1991) Novel approach to iatrogenic bile peritonitis. Surgery 109: 796–798

    Google Scholar 

  24. Moosa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H (1992) Laparoscopic injuries to the bile duct. Ann Surg 215: 203–208

    Google Scholar 

  25. Morgenstern L, Wong L, Berci G (1992) Twelve hundred open cholecystectomies before the laparoscopic era: a standard for comparison. Arch Surg 127: 400–403

    Google Scholar 

  26. Mueller PR, Ferrucci JT, Simeone JF, Cronan JJ, Wittenberg J, Neff CC, Sonnenberg E (1983) Detection and drainage of bilomas: special considerations. AJR Am J Roentgenol 140: 715–720

    Google Scholar 

  27. Palestrant AM, Vine HS, Sacks BA, Weinstein M, Ellison H (1983) Nonoperative drainage of fluid collections following operations on the biliary tract. Surg Gynecol Obstet 156: 305–309

    Google Scholar 

  28. Ponsky JL (1991) Complications of laparoscopic cholecystectomy. Am J Surg 161: 393–395

    Google Scholar 

  29. Quinn SF, Sangster W, Standdage B, Schuman E, Gross G (1992) Biliary complications related to laparoscopic cholecystectomies: radiologic diagnosis and management. Surg Laparosc Endosc 2: 279–286

    Google Scholar 

  30. Reddick EJ, Olsen DO (1987) Laparoscopic laser cholecystectomy. Surg Endosc 3: 131–133

    Google Scholar 

  31. Rees AM, Sarr MG, Nagorney DM, Farnell MB, Danohue JH, McIlrath DC (1993) Spectrum and management of major complications of laparoscopic cholecystectomy. Am J Surg 165: 655–661

    Google Scholar 

  32. Singh RP (1972) Bile peritonitis after cholecystectomy. Int Surg 57: 651–653

    Google Scholar 

  33. Soper NJ Flye MW, Brunt LM, Stockmann PT, Sicara GA, Picus D, Edmundowicz SA, Aliperti G (1993) Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg 165: 663–669

    Google Scholar 

  34. Sosa JL, Greenbergher SS, Livingstne AS, Levi JU (1991) Laparoscopic ligation of a leaking cystic duct. J Laparoendosc Surg 1: 211–215

    Google Scholar 

  35. Toriumi D, Ruchim M, Goldber M, Velasco J, Silver J, Berkowitz G, Atlas B (1989) Transnasal biliary drainage for treatment of common bile duct leakage and bile peritonitis. Dig Dis Sci 34: 315–319

    Google Scholar 

  36. Van Linden W, Gedda S, Edlund G (1981) Randomized trial of drainage after cholecystectomy, suction versus static drainage through a main wound versus a stab incision. Am J Surg 141: 289–294

    Google Scholar 

  37. Vujic I, Brock JG (1982) Biloma: aspiration for diagnosis and treatment. Gastrointest Radiol 7: 251–254

    Google Scholar 

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Authors and Affiliations

  1. The General Infirmary at Leeds, Leeds Institute for Minimally Invasive Therapy (LIMIT) and University Department of Surgery, Great George Street, LS1 3EX, Leeds, UK

    J. L. A. Albasini, V. S. Aledo, S. P. L. Dexter, J. Marton, I. G. Martin & M. J. McMahon

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  1. J. L. A. Albasini
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  2. V. S. Aledo
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  3. S. P. L. Dexter
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  4. J. Marton
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  5. I. G. Martin
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  6. M. J. McMahon
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Albasini, J.L.A., Aledo, V.S., Dexter, S.P.L. et al. Bile leakage following laparoscopic cholecystectomy. Surg Endosc 9, 1274–1278 (1995). https://doi.org/10.1007/BF00190158

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  • DOI: https://doi.org/10.1007/BF00190158

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