CYSTIC DUCT LEAKS IN LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: Cystic duct leak (CDL) appears to complicate laparoscopic cholecystectomy (LC) more often than open cholecystectomy (OC). No men tion of CDL was found in a literature review that covered 48,822 OCs a nd their complications. PATIENTS AND METHODS: Fifty-four patients who developed biliary tract injuries following LC were reviewed for: the t ime from LC to presentation, presenting symptoms, method of diagnosis, treatment, outcome, and follow-up. RESULTS: Seventeen of 54 biliary t ract complications (31%) were CDLs. The CDLs presented at a median of 4 days after LC with pain (16%) and nausea and/or vomiting (35%). Endo scopic retrograde cholangiopancreatography (ERCP) defined the diagnosi s and the anatomy of the leak in 11 patients (65%). Biliary endoprosth esis placement was employed in 8 patients, with concomitant sphinctero tomy in 5 (63%), and resolved CDL in every case. Seven (88%) of these patients were asymptomatic at a median interval of 10 months after ste nt retrieval. Six patients (35%) underwent reoperation. Five had lapar otomy with ligation of the cystic duet stump and 1 underwent laparosco pic examination with reclipping of the cystic duct stump. Five (83%) w ere asymptomatic at a median follow-up of 26 months. CDLs may result f rom inaccurate clip placement, perforations proximal to the clips, and stump necrosis, as documented at reoperation. CONCLUSIONS: CDLs occur more frequently in LC than in the OCs reported in the literature. Mos t leaks require intervention. ERCP with stent placement is the diagnos tic and therapeutic procedure of choice and has a high success rate of resolving leaks. To forestall CDLs, it is important to place clips ac curately and avoid electrocautery in the vicinity of the cystic duct.