Iraqi Postgraduate Medical Journal

Abstract

BACKGROUND:
Bile leak after laparoscopic cholecystectomy is not an uncommon complication, it’s a serious one and its management requires a lot of resources, and expertise. The evolution of laparoscopic cholecystectomy and being the standard of management had a disadvantage of slightly elevating bile leak incidence.
OBJECTIVE:
To identify the best way management to decrease the burden on the patient either quick healing, decrease complications and outline the complications after management modalities.
PATIENTS AND METHODS:
This is a prospective study describing route of management from the period January 2018- January 2019 in Al-Yarmouk Hospital and Gastrointestinal and hepatology teaching Hospital. Where 34 patients enrolled for bile leak after laparoscopic cholecystectomy. Patients were followed from their admission, investigations, determining site of leakage, choosing the method of management according to out-put grade, site. Comparing closure time and complications related to each.
RESULTS:
The study involved 34 patients who were managed for bile leak, mean age 42.13. Females were 76.5% (26), males were 23.5% (8). ERCP and MRCP used to determine the site of leakage: cystic duct 55.9% (19), liver bed 8.8% (3) and major duct injuries: Strasberg D 32.4% (11) and Strasberg E1 2.9% (1). These sites further divided in to low-grade <300 cc/day 73.5% (25) and high-grade >300 cc/day 26.5% (9). Management was according to site and grade of leak: conservative 23.5% (8), Endoscopic Retrograde Cholangiopancreatography alone/stent 70.6% (24) and surgical reconstruction 5.9% (2).             All patients were followed for 4 months. These modalities compared to each other in terms of closure time and complications.
CONCLUSION:
Some patients with bile leak can be managed using conservative measures alone. Sphincterotomy alone can be used in low grade leaks, from cystic duct. High grade, major duct injuries is best managed with sphincterotomy plus stenting to enhance healing.
Although conservative management or sphincterotomy alone decreases the complications rate but carries a disadvantage of delaying closure time.
Sphincterotomy plus stenting enhances closure time over other methods.