SUCCESSFUL TREATMENT OF POSTCHOLECYSTECTOMY BILE LEAKS USING NASOBILIARY TUBE DRAINAGE AND SPHINCTEROTOMY

Objective: Bile leaks are known complications of cholecystectomy. The combination of sphincterotomy and nasobiliary tube (NET) drainage is e ffective for the immediate decompression of bile ducts and provides ac cess for follow-up cholangiography. Our objective was to study, retros pectively, 19 patients who had undergone treatment for bile leaks with this combination between October 1991 and December 1995. Methods: Nin eteen patients (15 F, 4 M) ages 23-83 yr (mean 50 yr) presented with b ile leaks secondary to open cholecystectomy (n = 1) and laparoscopic c holecystectomy (n = 18). All patients had sphincterotomy and NET place ment. Symptoms, findings at ERCP, and outcome were reviewed. Results: Patients presented from 0 to 150 days after cholecystectomy (median = 2) with pain (n = 17), fever (n = 8), bile leakage in a surgical drain (n = 4), elevated liver tests (n = 8), and nausea and vomiting (n = 4 ). Fourteen patients had diagnostic imaging before endoscopic manageme nt. ERCP findings included cystic stump leak (n = 12), including one w ith a colocutaneous biliary fistula, gallbladder fossa leak (n = 3), r ight hepatic branch leak (n = 1), or no leak (n = 3). Three patients h ad choledocholithiasis. NET drainage was used for a mean of 3.9 days ( range 1-12 days). Fourteen patients had radiographic evidence of leak closure. One patient ultimately required surgical correction for a chr onic colocutaneous biliary fistula. There were no early or late endosc opic complications. Conclusions: Endoscopic management with nasobiliar y drainage and sphincterotomy is effective for acute uncomplicated bil e leaks but may not be adequate for chronic fistulas. The advantages o ver endoprostheses include access for subsequent cholangiography, impr oved biliary decompression, and catheter removal without further endos copy.