Management of postlaparoscopic cholecystectomy bile leakage: in the presence of MRCP, when to send the patient to undergo ERCP? | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 39, Issue 2, April 2020 PDF (347.98 K) | ||||
| DOI: 10.4103/ejs.ejs_6_20 | ||||
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| Authors | ||||
| Taher H. Elwan; Mokhtar A. Bahbah | ||||
| Abstract | ||||
| Objective The aim was to investigate cases of postlaparoscopic cholecystectomy (LC) bile leakage and aim to check if endoscopic retrograde cholangiopancreatography (ERCP) is mandatory for every patient or only for selected cases. Patients and methods The present study includes 35 patients who had a bile leak following LC and subjected to conservative (nonoperative) management and had a patent biliary tree and normal anatomy in the magnetic resonance cholangiopancreatography (MRCP) study. Patients were distributed into two groups. Group A included 20 patients who did not undergo an ERCP, while the second group included 15 patients who underwent an ERCP from the start. The efficacy and outcomes of both lines of management and the time needed to fistula closure were studied. Data were collected, recorded, and statistically analyzed. The results In group A, conservative management succeeded in 18/20 of patients, while the remaining two patients were sent to undergo ERCP due to a distressing bile leakage after a time of conservative management. In group B, the first ERCP failed to help in the cessation of bile leak in 2/15 patients (13%), so they underwent a second ERCP. The mean hospital stay was higher (but not significant) in the non-ERCP group, 5.19±4.72 vs 4.88±3.41 days in the ERCP group. The pain scores, fever, and many other morbidities were higher in the ERCP group. Conclusion In post-LC bile leak, ERCP is not mandatory for patients who have a patent biliary tree with normal anatomy in MRCP study. In these patients, ERCP is better to be avoided as an initial step and should be restricted to the resistant cases. | ||||
| Keywords | ||||
| Bile leak; conservative management; Endoscopic retrograde cholangiopancreatography; Laparoscopic cholecystectomy | ||||
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