ENDOSCOPIC MANAGEMENT OF BILIARY LEAK AFTER CHOLECYSTECTOMY. AN INITIAL STUDY | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 4, October 2003, Page 336-342 PDF (209.82 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374246 | ||||
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| Author | ||||
| Ayman M. Hassanien* | ||||
| Department of General Surgery, El-Minia University Hospitals | ||||
| Abstract | ||||
| Biliary leak after cholecystectomy ranges from 0.1% to 3% and is more common with laparoscopic choleystectomy than with open procedure. Endoscopic management for postcholecystectomy biliary leak was developed to avoid the high morbidity and mortality rates associated with surgical therapy. The aim of this prospective study was to evaluate the initial results of endoscopic management of patients with biliary leak after cholecystectomy. Between July 1999 and July 2002, 31 patients (18 men and 13 women, aged from 16 to 67 with mean age 49 + 12.1 years) underwent endoscopic management for postcholecystectomy bile leak in the Endoscopy Unit of El-Minia University Hospital. The mean time from cholecystectomy to ERCP was 6.9 + 3.2 days. Presenting clinical features included abdominal pain in 25 patients (80.6%), jaundice in 7 patients, biliocutaneous fistula in 8 patients (25.8%) and biloma in 7 patients (22.6%). ERCP successfully demonstrated the precise location of the leak in all cases. The leak originated from the cystic duct in 16 patients (51.6%), the common bile duct (CBD) in 10 patients (32.2%), and the right hepatic duct in 5 patients (16.1%). Methods of endoscopic treatment included endoscopic sphincterotomy (ES) in 4 patients (12.9%), endoscopic stenting in 8 patients (25.8%), endoscopic sphincterotomy and stenting in 14 patients (45.1%), endoscopic sphincterotomy and naso-biliary drainage tube (NBDT) in 3 patients (9.6%). Endoscopic management was effective in 29 of 31 patients (93.5%), safe, without mortality and the reported complications were treated effectively by endoscopic management. The mean hospital stay for treatment of the leak was 6.1 + 4.3 days. The patients were free of biliary symptoms at a mean follow-up period of 12 + 6.2 months (range 9 – 30 months) after completion of endoscopic therapy. Surgical therapy was done in two patients of complete transection of CBD. Conclusion: ERCP and endoscopic procedures are safe and effective in the diagnosis and treatment of biliary leak after cholecystectomy. Long-term follow-up is required in patients who undergo endoscopic drainage for detection of subsequent biliary stricture formation. Surgical repair of completely transected CBD is still the standard treatment. | ||||
| Keywords | ||||
| Endoscopic management; biliary leak; cholecystectomy | ||||
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