Abstract
Objectives: To determine the outcome of endoscopic intervention in the control of post-cholecystectomy bile leak
Design: Retrospective study
Setting: Department of Surgery, College of Medicine, King Saud University, Saudi Arabia
Subjects: This study included all consecutive patients with bile leak after cholecystectomy who were managed in the department of Surgery at King Saud Medical City from July 1, 2005 till June 30, 2015.
Intervention: Medical records of all the patients were reviewed and the data were collected retrospectively.
Main outcome measures: Bile leak was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) in all patients. Endoscopic sphincterotomy (ES) with bile duct stenting was performed in the same setting.
Results: A total of 121 patients were managed with bile leak after cholecystectomy. All patients underwent ES and stent insertion. Bile leak was successfully controlled in 88 (73%) patients; 79 patients with type A, 3 with type C, and 6 with type D injury. Endoscopic management was not definitive in 33 (27%) patients. These patients included 3 type C, 5 type D and 25 type E injuries. Twelve ERCP-related complications (4%) were reported; mild pancreatitis (n = 7), cholangitis (n = 2), bleeding (n = 2), and duodenum perforation (n = 1).
Conclusions: Two-third of bile leaks after cholecystectomy was due to lesser bile duct injuries and was amenable to definitive endoscopic therapy. One-third of patients had major biliary injury that required surgical intervention. Endoscopic intervention is recommended as the preferred and safe primary modality for the diagnosis and treatment of post-cholecystectomy bile leak.