BILE LEAK AFTER CHOLECYSTECTOMY SIGNIFICANCE AND TREATMENT - RESULTS FROM THE NATIONAL NORWEGIAN CHOLECYSTECTOMY REGISTRY

From April 1993 to July 1995, altogether 3860 procedures were enrolled in the Norwegian National Cholecystectomy Registry (NNCR), 777 (20.2% ) being open operations. 3083 (79.8%) were initiated laparoscopically, 313 (10.2%) of these converted to open technique. Mortality within 30 days after open cholecystectomy was 1.9%, after a converted procedure 1.0% and 0.14% after laparoscopic cholecystectomy (p<0.01). According to the intention to treat principle, converted procedures should be i ncluded in the laparoscopic group. This gives seven deaths after 3083 procedures, i.e. 0.23%. Postoperative death still occurs approximately 10 times more frequently after open cholecystectomy (p<0.01), However , this is partly due to selection of high risk cases to open technique . Postoperative bile leak was observed in 25 patients (0.9%) in the la paroscopic, 13 (4.2%) in the converted and 19 (2.4%) in the open group . Bile leak contributed significantly to serious complications. 37 maj or problems were observed in 25 of the patients (44%). Five patients d ied (8.8%), Among the 57 bile leak patients, common bile duct (CBD) in jury was found in 13 (22.8%). Additional 19 CBD injuries occurred, pre senting with other symptoms such as icterus, or being recognised durin g the first operation, The frequency of CBD injury in the laparoscopic group was 14 (0.5%), in the converted group 12 (3.8%) and in the open group 6 (0.8%). None of the patients with CBD injury underwent intrao perative cholangiography. The present results firstly show that open c holecystectomy cannot be considered a safe procedure for high risk pat ients, secondly, that postoperative bile leak contributes significantl y to postoperative mortality and hence is a serious condition generati ng from CBD injury in about 1/5 of all cases.