Successful Endoscopic Management of Bile Leak: A Single-Center Experience

ABSTRACT

Background and Aims: Bile leak is a rarely encountered complication most commonly occurring in the setting of biliary tract surgery. Site of leak may be from the gallbladder bed, the cystic duct, or rarely from injury to a major bile duct. Management has evolved with from radical surgery prevalent in earlier days to recent increased expertise in biliary endoscopy. This study aims to determine the impact of endoscopic management in treating symptomatic bile leak and discusses the role of surgery. Patients and Methods: In this retrospective study, patients with symptomatic bile leak admitted between 2012 and 2015 to the Department of Gastroenterology of a tertiary care center in Western India were analyzed. Site and extent of bile leak was evaluated using contrast enhanced computed tomography or magnetic resonance cholangiopancreatography. Endoscopic retrograde cholangiopancreatography (ERCP) was mainly used as a therapeutic tool rather than a diagnostic tool. ERCP was used as a primary mode of treatment wherever feasible. Percutaneous biliary drainage was used in technically difficult cases. Results: Twenty-seven patients with symptomatic bile leak were identified in aforesaid period. Bile leak in 21 (77.88%) patients was due to postlaparoscopic cholecystectomy injury, while in 6 (22.22%) patients, it was associated with liver abscess. Major bile duct injury was seen in 10 patients with postcholecystectomy status and in 5 patients with liver abscess. Out of 27 cases, 25 (92.59%) were treated with ERCP and 2 (7.40%) with percutaneous drainage. Surgery was not required in any of the patients. Sphincterotomy with stent placement for 6 weeks was effective in 23 (92%) patients, and only sphincterotomy was effective in 2 (8%) patients undergoing ERCP. There was no mortality due to bile leak. Conclusion: Most patients presenting with bile leak including major bile duct injury without complete bile duct transection can be successfully treated by endoscopic therapy without the need for surgery.

KEYWORDS

Bile leak - laparoscopic cholecystectomy - therapeutic endoscopic retrograde cholangiopancreatography

• References

• 1 Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G. et al. The European experience with laparoscopic cholecystectom. Am J Surg 1991; 161: 385-7
• 2 Bailey RW, Zucker KA, Flowers JL, Scovill WA, Graham SM, Imbembo AL. et al. Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann Surg 1991; 214: 531-40
• 3 Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D. et al. Characteristics of biliary tract complications during laparoscopic cholecystectomy: A multi-institutional study. Am J Surg 1994; 167: 27-33
• 4 Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: An analysis on 114,005 cases of United States series. Int Surg 1998; 83: 215-9
• 5 Merrie AE, Booth MW, Shah A, Pettigrew RA, McCall JL. Bile duct imaging and injury: A regional audit of laparoscopic cholecystectomy. Aust N Z J Surg 1997; 67: 706-11
• 6 McMahon AJ, Fullarton G, Baxter JN, O’Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1995; 82: 307-13
• 7 Buanes T, Waage A, Mjáland O, Solheim K. Bile leak after cholecystectomy significance and treatment: Results from the National Norwegian Cholecystectomy Registry. Int Surg 1996; 81: 276-9
• 8 Griffin J, Jennings C, Owens A. Hepatic amoebic abscess communicating with the biliary tree. Br J Radiol 1983; 56: 887-90
• 9 De Palma GD, Galloro G, Iuliano G, Puzziello A, Persico F, Masone S. et al. Leaks from laparoscopic cholecystectomy. Hepatogastroenterology 2002; 49: 924-5
• 10 Mergener K, Strobel JC, Suhocki P, Jowell PS, Enns RA, Branch MS. et al. The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy. Gastrointest Endosc 1999; 50: 527-31
• 11 Ryan ME, Geenen JE, Lehman GA, Aliperti G, Freeman ML, Silverman WB. et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: A multicenter review. Gastrointest Endosc 1998; 47: 261-6
• 12 Chun K. Recent classifications of the common bile duct injury. Korean J Hepatobiliary Pancreat Surg 2014; 18: 69-72
• 13 Neidich R, Soper N, Edmundowicz S, Chokshi H, Aliperti G. Endoscopic management of bile duct leaks after attempted Minimally invasive management of bile leak after laparoscopic cholecystectomy laparoscopic cholecystectomy. Surg Laparoendosc Endosc 1996; 5: 348-54
• 14 Azurin DJ, Go LS, Maslack M, Kirkland ML. Bile leak following laparoscopic cholecystectomy. J Laparoendosc Surg 1995; 5: 233-6
• 15 Ponchon T, Gallez JF, Valette PJ, Chavaillon A, Bory R. Endoscopic treatment of biliary tract fistulas. Gastrointest Endosc 1989; 35: 490-8
• 16 Liguory C, Vitale GC, Lefebre JF, Bonnel D, Cornud F. Endoscopic treatment of postoperative biliary fistulae. Surgery 1991; 110: 779-83
• 17 Contractor QQ, Dubian MK, Boujemla M, Contractor TQ. Endoscopic therapy after laparoscopic cholecystectomy. J Clin Gastroenterol 2001; 33: 218-21
• 18 Chow S, Bosco JJ, Heiss FW, Shea JA, Qaseem T, Howell D. et al. Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterotomy. Am J Gastroenterol 1997; 92: 1839-43
• 19 Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA. et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: Perioperative results in 200 patients. Ann Surg 2005; 241: 786-92