BILE LEAKAGE AFTER BILIARY-TRACT SURGERY - A LAPAROSCOPIC PERSPECTIVE

The incidence of bile leaks has increased with laparoscopic cholecyste ctomy as compared with open cholecystectomy. Minor bile leaks are not infrequent but are clinically insignificant; of the major bile leaks t he most common sequela is the biloma, the most serious, bile peritonit is. Early symptoms may be very subtle; all untoward symptoms should be investigated with a HIDA scan to rule out bile leakage. Positive HIDA scans should be followed with endoscopic retrograde cholangiography ( ERC) or percutaneous transhepatic cholangiography (PTC). Management of the leakage depends on identification of its source. Prompt identific ation of ductal injuries permits earlier effective treatment and conse quently less morbidity and/or mortality.