ENDOSCOPIC MANAGEMENT OF BILE-DUCT LEAKS AFTER ATTEMPTED LAPAROSCOPICCHOLECYSTECTOMY

Fourteen patients with symptomatic bile duct leaks following laparosco pic cholecystectomy were treated using endotherapeutic techniques. Pat ients presented with abdominal pain, liver test abnormalities, jaundic e, leukocytosis, and fever. Twelve leaks originated from cystic duct s lumps and two from right posterior hepatic ducts. Distal biliary obstr uction, which may have promoted leakage, was present in five patients. Treatment methods included stent insertion with endoscopic sphinctero tomy (ES), stent insertion without ES, and nasobiliary tube (NBT) plac ement without ES. Eleven of 14 patients had prompt resolution of their bile leaks following initial endotherapy. Three patients with continu ed Leakage underwent successful repeat endoscopic retrograde cholangio pancreatography 4-5 days after the initial examination. Cholangiograph ic evidence of leak closure was documented in all patients, and all re mained asymptomatic during an average follow-up period of 18.5 months. Endoscopic therapy is safe and effective treatment for clinically sig nificant bile leaks following laparoscopic cholecystectomy. In our sma ll group of patients, NBT alone did not appear to be as effective as e ndoprostheses with or without ES. The ideal endoscopic treatment metho d has not yet been established but will likely vary depending on the s ite and specific nature of the injury and any concomitant biliary duct al pathology.