| Abstrakt: |
The aim of this retrospective study is to analyze the causes of bile leaks after laparoscopic cholecystectomy and the possible options for their management. Material and methods: Between January 2011 and December 2020, 1196 patients underwent laparoscopic cholecystectomy in our department. Postoperative bile leaks occurred in 15 patients. The amount of bile discharge, associated complications, need for interventional management, morbidity and mortality were evaluated. Results: All but one patients were diagnosed during the first 24 postoperative hours. In 4 patients with a low output from the drain, bile leak was resolved spontaneously. Among the 11 patients with major bile leakage and signs of biliary peritonitis, 6 underwent a laparotomy. In 2 cases, a dislodgement of a clip and an orifice near the clip in the cystic-hepatic junction was identified. In one case the lesion was dealt with by suturing the injury over a T-tube and drainage of the underlying biloma and in the other one with ligature of the cystic stump. One case of leakage from the cystic duct stump was managed with ligation of the stump. Finally, in the remaining 3 cases the leakage was coming from an accessory bile duct in the liver bed. The accessory duct was ligated and the liver bed sutured. Five patients with mild symptoms underwent endoscopic retrograde cholangiopancreatography (ERCP) which revealed leakage from the cystic duct in 4 cases and from a laceration of the common bile duct cystic in the remaining one. All cases were successfully managed in a tertiary center with ERCP - sphincterotomy and insertion of a stent into the bile duct. Complications due to the management of bile leaks included one deep vein thrombosis and two acute pancreatitis. Conclusions: Management of bile leaks after laparoscopic cholecystectomy depends on the output of bile, their cause and presence of associated complications. ERCP is the option of choice for both diagnosis and treatment of bile leaks complicating minor bile duct injuries, while conventional surgery is indicated in cases of major bile duct injury, severe biliary peritonitis or failed ERCP. [ABSTRACT FROM AUTHOR] |
