Postcholecystectomy bile leak. Serial hepatobiliary imaging and percutaneous drainage

Bile leak following laparoscopic cholecystectomy

The incidence and significance of bile leak after open cholecystectomy have been studied. The purpose of this study was to determine the incidence and significance of postoperative bile leak associated with both emergent and elective laparoscopic cholecystectomies. One thousand four hundred patients undergoing laparoscopic cholecystectomy from July 1990 to January 1995 were retrospectively reviewed. Twenty-seven percent of laparoscopic cholecystectomies were performed urgently for acute cholecystitis. Diisopropyl-iminodiacetic acid (DISIDA) scan was used to determine the presence of a bile leak or obstruction. Also, a subgroup of 63 patients from March to May of 1992 was studied in a nonblinded prospective fashion to determine the rate of asymptomatic bile leak. The incidence of bile leak in the subgroup of 63 patients was 4.7% (n = 3). All of these bile leaks were asymptomatic and of no clinical significance. The incidence of bile leak in the remaining 1337 was 0.14% (n = 2). These bile leaks were discovered by DISIDA scan following a workup of atypical abdominal pain following laparoscopic cholecystectomy. Both of these patients underwent ERCP with papillotomy. There were no ductal injuries in the entire series. Symptomatic bile leaks following laparoscopic cholecystectomy are rare. Asymptomatic bile leaks occur infrequently and are of no clinical significance.

Hepatobiliary scintigraphy after biliary tract surgery

Hepatobiliary scintigraphy provides a rapid, noninvasive, accurate means of assessing patients after biliary tract surgery. This is especially important, given the high incidence of biliary and enteric diseases. In this review article, the role of radionuclide imaging in postcholecystectomy and postgastroenteric surgery patients will be examined, as well as following invasive procedures and trauma.

Bile leak from the liver bed following laparoscopic cholecystectomy

Intraperitoneal accumulation of bile from accessory bile ducts following cholecystectomy is an uncommon, but well-described, occurrence. It is not unique to laparoscopic cholecystectomy. The presence of accessory channels between the liver and gallbladder has long been recognized by anatomists and surgeons. They are commonly known as the "ducts of Luschka". Recognition and treatment of liver bed bile leaks vary. Usually the surgeon can treat this problem without an exploratory celiotomy depending on availability of ERCP or interventional radiology. This article will review clinical diagnosis, radiologic confirmation, and treatment for this complication.

Endoscopic repair of bile leaks after laparoscopic cholecystectomy

Laparoscopic cholecystectomy has quickly eclipsed open cholecystectomy as the standard approach to symptomatic gallstones and acalculous biliary disease. Procedure-related morbidity and mortality continue to be defined, but a higher incidence of bile duct injuries has been reported to date using present technology and procedure. Key principles in the management of these problems include definition of the anatomy, relief of any impedance to biliary-enteric flow, and drainage of significant extrahepatic fluid collections. A cooperative, multispecialty approach involving surgeons, radiologists, and gastroenterologists is critical to successful outcomes. Future studies will help streamline the management of bile duct injuries and aid physicians in their selection of the best approach for each individual patient.

Cholescintigraphy in the diagnosis of the complications of laparoscopic cholecystectomy

Cholescintigraphy has been used to diagnose postoperative bile leaks and obstructions after open cholecystectomy. This imaging technique has been found to be sensitive for detecting bile leaks that arise from cholecystectomy and defects in the filling and emptying of bile ducts. These observations can be applied to patients who are suspected of having bile duct injury after laparoscopic cholecystectomy. Cholescintigraphy can detect a variety of bile leaks including those arising from the gallbladder fossa, cystic duct, and the common bile duct. In addition, cholescintigraphy can be used for management of patients after stenting or bypass surgery, to assess bile flow and operative sites for any residual bile leaks. Postoperative bile duct obstructions can also be seen with cholescintigraphy. In this article we discuss a comprehensive postoperative strategy for the management and diagnosis of biliary defects after laparoscopic cholecystectomy with cholescintigraphy.

The use of radionuclide imaging in the evaluation of suspected biliary damage during laparoscopic cholecystectomy

Laparoscopic cholecystectomy offers a reliable and effective alternative to the standard operative cholecystectomy with reduced morbidity and patient recovery time. We report three cases in which radionuclide hepatobiliary imaging was utilized to evaluate the integrity of the extrahepatic biliary ducts following suspected biliary damage during the procedure, documenting bile leakage in two of the patients.