Endoscopic nasobiliary drainage for treating bile & leak after laparoscopic cholecystectomy

BACKGROUND/AIMS: Bile leaks are common complications of laparoscopic cholec ystectomy. We evaluated the diagnosis and endoscopic treatment of bile leak s. METHODOLOGY: A total of 436 patients underwent laparoscopic cholecystectomy with infrahepatic drainage. We performed immediate endoscopic retrograde c holangiopancreatography (ERCP) on all patients with bile discharge? from an infrahepatic drain, and treated bile leaks which were not due to a major d uctal injury by endoscopic nasobiliary drainage (ENBD) without endoscopic s phincterotomy (ES). RESULTS: Ten patients developed bile leaks which were recognized within 18 hours of operation. ERCP, on post-operative day I or 2, showed a bile leak from the cystic duct (9 patients) or the liver bed (1 patient). All patient s underwent ENBD. Only I patient, who had a retained stone, had ES. In all patients, the bile leak resolved promptly and both the infrahepatic and nas obiliary drains were removed within 6 days of cholecystectomy. All patients were asymptomatic at a mean follow-up of 30 months. CONCLUSIONS: Routine placement of an infrahepatic drain is recommended for the early detection of bile leaks. Bile leaks can be successfully treated b y prompt ENBD without ES.