7252 The association of biliary leaks with choledocholithiasis following laparoscopic cholecystectomy.

Abstract

Complications of laparoscopic cholecystectomy has been well described. This list includes bile duct leak, retained stones, and partial or complete biliary transection. Several investigators have documented the efficacy of endoscopic treatment of individual complications. Rare reports have discussed the presence of choledocholithiasis coexisting with bile duct leaks following laparoscopic cholecystectomy. AIM: To determine the success of endoscopic therapy in patients presenting with choledocholithiasis and bile duct leaks following laparoscopic cholecystectomy. METHODS: Sixtythree patients presented over a ten year period with bile duct leaks following laparoscopic cholecystectomy. Of these, 9 patients were found to have concomitant retained bile duct stones. This included 7 woman, 2 men, age range 33-72 (mean 51 years). Cholangiogram demonstrated 7 patients with single stones (5 mm-15 mm, and 2 patients with multiple stones (6 mm-20 mm). Coexisting biliary leaks were noted at the cystic duct stump=8 and accessory duct of Lutscha=1. Patients presented 36 hours-5 days following laparoscopic cholecystectomy. All patients had abdominal pain and abnormal LFTs, 3 patients with N/V, 2 patients with fever, 5 patients with abdominal distension. RESULTS: All patients underwent successful cannulation and opacification of the bile duct. Endoscopic sphincterotomy was performed in all patients prior to stone extraction. Eight of 9 patients had stone extraction accomplished at initial ERCP while 1 of 9 patients required 2 ERCP sessions for complete stone extraction. Biliary stents were placed in all patients (10 Fr=6 patients, 7 Fr=3 patients)over a 4-9 week period (mean 5.5 weeks). Follow-up was available in all patients (range 8 months - 8 years). Resolution of leaks and stone clearance was demonstrated in all patients. No complications were observed in this study. CONCLUSION: Biliary leaks following laparoscopic cholecystectomy are associated with retained CBD stones in nearly 15% of patients. Resolution of bile leaks can be expected following extraction, ES, and stent placement within 4-9 weeks of therapy.