MANAGEMENT OF BILE LEAKS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

The success of laparoscopic cholecystectomy has been tarnished by the increased risk of bile duct damage associated with the operation. Many of these injuries can be managed by endoscopic techniques. Experience of such injuries between 1991 and 1994 was reviewed. Twenty-four pati ents were referred: 11 with injuries to the cystic duct alone, five wi th complete hepatic duct obstruction and eight with high bile duct lea ks. All patients with leaks from the cystic duct were managed successf ully endoscopically (sphincterotomy, four; stent, seven) without recou rse to further surgery. Patients with complete obstruction were aided in their recovery by endoscopic and percutaneous techniques, either fo r postoperative problems (two patients) or in preparation for surgery (three). The eight patients with high bile duct leaks were managed end oscopically by stenting (seven patients) or sphincterotomy (one). Sten ting appeared to encourage leaks to heal better than sphincterotomy al one; stents should probably be left in situ for 2 months before remova l. There were no deaths and all but one patient had normal biliary fun ction at follow-up. It is suggested that ail suspected injuries after biliary surgery require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be req uired only if there is complete obstruction of the biliary tree.