Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy

Background: Bile leakage in the absence of major ductal injury may occur fr om the liver bed or from the cystic duct remnant after cholecystectomy. The early limitations of minimally invasive surgery led to reliance on endosco pic methods to manage this complication. However, repeat laparoscopy permit s drainage of the bile collection and direct control of the site of leakage in selected situations. Methods: Details of 15 patients with bile leakage after laparoscopic cholec ystectomy were recorded prospectively and are reviewed. Results: Postoperative bile leakage occurred after 15 (0.8 per cent) of 177 9 laparoscopic chole-cystectomies. Two patients with bile in drainage fluid had spontaneous resolution. Ten patients with a subvesical duct leak had r epeat laparoscopy. The leak was successfully controlled by suturing in eigh t patients, and by a laparoscopically placed drain in two. One patient requ ired a subsequent laparotomy for a loculated pelvic collection. Three patie nts had cystic duct stump leakage. This was managed successfully by laparos copy in one case but required endoscopic management in two. Conclusion: Laparoscopy is useful in the management of minor bile leaks aft er laparoscopic chole-cystectomy. Selection of appropriate patients relies on a characteristic clinical presentation after an otherwise uncomplicated cholecystectomy.