Clin Endosc.  2014 May;47(3):248-253. 10.5946/ce.2014.47.3.248.

Endoscopic Management of Bile Leakage after Cholecystectomy: A Single-Center Experience for 12 Years

• Kim KH
• Kim TN

• KMID: 2049021
• DOI: http://doi.org/10.5946/ce.2014.47.3.248

Abstract

BACKGROUND/AIMS
Bile leakage is an uncommon but serious complication of cholecystectomy. The aim of this study is to evaluate the efficacy of the endoscopic management of bile leakage after cholecystectomy.
METHODS
A total of 32 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), because of bile leakage after cholecystectomy, from January 2000 to December 2012 were reviewed retrospectively. The clinical parameters, types of management, and procedure-related complications were documented.
RESULTS
Most bile leakages presented as percutaneous bile drainage through a Hemovac (68.8%), followed by abdominal pain (18.8%). The sites of bile leaks were the cystic duct stump in 25 patients, intrahepatic ducts in four, liver beds in two, and the common bile duct in one. Biliary stenting with or without sphincterotomy was performed in 22 and eight patients, respectively. Of the four cases of bile leak combined with bile duct stricture, one patient had severe bile duct obstruction and the others had mild stricture. Concerning endoscopic modalities, endoscopic therapy for bile leak was successful in 30 patients (93.8%). Two patients developed transient post-ERCP pancreatitis, which was mild, and both recovered without clinical sequelae.
CONCLUSIONS
The endoscopic approach of ERCP should be considered a primary modality for the diagnosis and treatment of bile leakage after cholecystectomy.

Keyword

Bile leak; Sphincterotomy, endoscopic; Cholecystectomy, laparoscopic

MeSH Terms

Abdominal Pain
Bile Ducts
Bile*
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy*
Cholecystectomy, Laparoscopic
Cholestasis
Common Bile Duct
Constriction, Pathologic
Cystic Duct
Diagnosis
Drainage
Humans
Liver
Pancreatitis
Retrospective Studies
Sphincterotomy, Endoscopic
Stents

Figure

• 

  Fig. 1 Endoscopic retrograde cholangiopancreatogram and follow-up cholangiogram of a cystic stump bile leak. (A) Extravasation of contrast was observed in the region of the cystic duct stump by cholangiography. Percutaneous catheter for the drainage of the biloma is also noted. (B) A plastic stent (10 Fr, 7 cm) was placed through the ampullary orifice. (C) No bile leak was evident after stent removal 6 weeks later.

Reference

1. Bergman JJ, van den Brink GR, Rauws EA, et al. Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut. 1996; 38:141–147. PMID: 8566842.

2. Kim JH, Kim WH, Kim JH, Yoo BM, Kim MW. Management of patients who return to the hospital with a bile leak after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2010; 20:317–322. PMID: 20465428.

3. Massoumi H, Kiyici N, Hertan H. Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol. 2007; 41:301–305. PMID: 17426471.

4. Binmoeller KF, Katon RM, Shneidman R. Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol. 1991; 86:227–231. PMID: 1992640.

5. Bjorkman DJ, Carr-Locke DL, Lichtenstein DR, et al. Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough. Am J Gastroenterol. 1995; 90:2128–2133. PMID: 8540501.

6. Barkun AN, Rezieg M, Mehta SN, et al. Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management. McGill Gallstone Treatment Group. Gastrointest Endosc. 1997; 45:277–282. PMID: 9087834.

7. Agarwal N, Sharma BC, Garg S, Kumar R, Sarin SK. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int. 2006; 5:273–277. PMID: 16698590.

8. Davids PH, Rauws EA, Tytgat GN, Huibregtse K. Postoperative bile leakage: endoscopic management. Gut. 1992; 33:1118–1122. PMID: 1398239.

9. Soper NJ, Flye MW, Brunt LM, et al. Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg. 1993; 165:663–669. PMID: 8506964.

10. Tzovaras G, Peyser P, Kow L, Wilson T, Padbury R, Toouli J. Minimally invasive management of bile leak after laparoscopic cholecystectomy. HPB (Oxford). 2001; 3:165–168. PMID: 18332919.

11. Foutch PG, Harlan JR, Hoefer M. Endoscopic therapy for patients with a post-operative biliary leak. Gastrointest Endosc. 1993; 39:416–421. PMID: 8514079.

12. Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc. 2005; 61:269–275. PMID: 15729238.

13. Wootton FT, Hoffman BJ, Marsh WH, Cunningham JT. Biliary complications following laparoscopic cholecystectomy. Gastrointest Endosc. 1992; 38:183–185. PMID: 1533197.

14. Peters JH, Ollila D, Nichols KE, et al. Diagnosis and management of bile leaks following laparoscopic cholecystectomy. Surg Laparosc Endosc. 1994; 4:163–170. PMID: 8044356.

15. Christoforidis E, Vasiliadis K, Goulimaris I, et al. A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation. J Surg Res. 2007; 141:171–175. PMID: 17499275.

16. Marks JM, Ponsky JL, Shillingstad RB, Singh J. Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks. Surg Endosc. 1998; 12:327–330. PMID: 9543522.

17. Leung JW, Cotton PB. Endoscopic nasobiliary catheter drainage in biliary and pancreatic disease. Am J Gastroenterol. 1991; 86:389–394. PMID: 2012035.

18. Sandha GS, Bourke MJ, Haber GB, Kortan PP. Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc. 2004; 60:567–574. PMID: 15472680.

19. Barton JR, Russell RC, Hatfield AR. Management of bile leaks after laparoscopic cholecystectomy. Br J Surg. 1995; 82:980–984. PMID: 7648125.

20. Pinkas H, Brady PG. Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int. 2008; 7:628–632. PMID: 19073409.

21. Ahmad F, Saunders RN, Lloyd GM, Lloyd DM, Robertson GS. An algorithm for the management of bile leak following laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2007; 89:51–56. PMID: 17316523.

22. Ryan ME, Geenen JE, Lehman GA, et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review. Gastrointest Endosc. 1998; 47:261–266. PMID: 9540880.

23. Coelho-Prabhu N, Baron TH. Assessment of need for repeat ERCP during biliary stent removal after clinical resolution of postcholecystectomy bile leak. Am J Gastroenterol. 2010; 105:100–105. PMID: 19773748.

24. Do IN, Kim JC, Park SH, et al. The outcome of endoscopic treatment in bile duct injury after cholecystectomy. Korean J Gastroenterol. 2005; 46:463–470. PMID: 16371721.