Korean J Intern Med.  2017 Jan;32(1):79-84. 10.3904/kjim.2015.165.

The outcome of endoscopic management of bile leakage after hepatobiliary surgery

• Yun SU
• Cheon YK
• Shim CS
• Lee TY
• Yu HM
• Chung HA
• Kwon SW
• Jeong TG
• An SH
• Jeong GW
• Kim JW

• KMID: 2365981
• DOI: http://doi.org/10.3904/kjim.2015.165

Abstract

BACKGROUND/AIMS
Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery.
METHODS
The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy.
RESULTS
Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy.
CONCLUSIONS
The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Keyword

Bile leakage; Hepatobiliary surgery; Stents; Sphincterotomy, endoscopic

MeSH Terms

Abdominal Pain
Bile Ducts
Bile*
Catheterization
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis
Common Bile Duct
Congenital Abnormalities
Constriction, Pathologic
Cystic Duct
Diagnosis
Drainage
Hepatic Duct, Common
Humans
Liver
Medical Records
Patient Care
Retrospective Studies
Sphincterotomy, Endoscopic
Stents