DIAGNOSIS OF POSTOPERATIVE BILE LEAKS

Bile leaks are the most common biliary complication of laparoscopic ch olecystectomy. Cholescintigraphy has been utilized in the past to diag nose postoperative bile leaks after open cholecystectomy. However, the sensitivity and specificity of this imaging technique has not been de fined or compared to other clinical tests. We have retrospectively stu died 30 patients over a 2-yr period who underwent cholescintigraphy fo r a possible postoperative bile leak. This study reviewed the cholesci ntigraphy images, clinical presentations, and abdominal ultrasonograph y/CT scanning. Using a gold standard that consisted of the findings of cholangiography and clinical outcome, we determined the diagnostic ac curacy of these tests. Symptoms, laboratory testing, and physical exam ination were found to be poor predictors for the presence of postopera tive bile leaks. Ultrasound and CT imaging were less sensitive and non specific. In contrast, cholescintigraphy was found to be quite accurat e (83-87%) for predicting the presence of bile leaks after laparoscopi c cholecystectomy, as well as other biliary surgeries.