POSTCHOLECYSTECTOMY EXTERNAL BILIARY FISTULA

Background: External biliary fistula (EBF) following bile duct injury is a serious complication of cholecystectomy. Methods: From January 19 89 to December 1994, 37 patients with post-cholecystectomy external bi liary fistula were seen at this centre. There were 14 partial, 22 comp lete and one sub-vesical duct of Luschka injury. Sixteen patients had a controlled EBF at presentation; 10 patients had intra-abdominal coll ections and seven patients presented with peritonitis. Results: A stag ed approach to the management of these patients was adopted in which t he initial management aimed at creating a 'controlled' fistula. This a pproach comprised conservative treatment (n = 9), percutaneous cathete r drainage of intra-abdominal collections (n = 10), biliary drainage ( n = 6), and surgical intervention (n = 7). One patient died because of progressive Liver failure in spite of intensive management. Definitiv e management comprised the surgical repair of biliary strictures where ver indicated, after waiting for the acute problems to settle. Conclus ions: By adopting a staged approach along with a judicious use of endo scopy, radiology and surgery that were based on clinical circumstances , it was possible to achieve satisfactory results for this otherwise d istressing condition.