ENDOSCOPIC INTERVENTION FOR BILIARY LEAKS AFTER LAPAROSCOPIC CHOLECYSTECTOMY - A MULTICENTER REVIEW

Background: Endoscopic therapy of biliary tract leaks was uncommon bef ore laparoscopic cholecystectomy, Studies have demonstrated the effica cy of endoscopic drainage by endoscopic sphincterotomy or stent placem ent, Various endoscopic therapeutic modalities and long-term follow-up of this problem were studied, Methods: Members of the Midwest Pancrea ticobiliary Group reviewed all patients referred for endoscopic therap y of biliary leaks after laparoscopic cholecystectomy from 1990 to 199 4, Long-term follow-up was by direct patient contact. Results: Fifty p atients were referred for endoscopic therapy of biliary leaks, Abdomin al pain was present in 94%, The mean time from laparoscopic cholecyste ctomy to referral was 6.9 days. Therapy consisted of sphincterotomy on ly in 6 patients, stent only in 13, and sphincterotomy with stent in 3 1, Biliary leaks were healed in 44 patients at a mean of 5.4 weeks, A second or third endoscopic procedure was necessary to achieve healing in five patients, Two stent-related complications were noted, Percutan eous or surgical drainage of biliary fluid collections was required in 16 patients, The mean hospital stay for treatment of the leak was 11. 1 days after endoscopic therapy, On follow-up (mean 17.5 months), all patients were well except two with mild abdominal discomfort. Conclusi ons: Endoscopic sphincterotomy, stent placement, or sphincterotomy wit h stent are effective in healing biliary leaks after laparoscopic chol ecystectomy, Despite prolonged treatment for the leak, patients did we ll on long-term follow-up.