Approach to a Patient with Post Laparoscopic Cholecystectomy Bile Leak

Abstract

With the widespread practice of laparoscopic cholecystectomy and the advancements in imaging and endoscopic therapy the management of bile leaks following cholecystectomy has evolved over the years. Majority of the bile leaks are detected post-operatively. A high index of suspicion should exist for a possible bile leak if a patient presents with abdominal pain, fever, and tenderness within a week following a complicated or converted laparoscopic cholecystectomy, or it may present as an overt external biliary fistula. Leaks which are detected intra-operatively and managed appropriately carry the best prognosis. Interventional radiologists along with expert endoscopists can successfully manage many of the minor bile leaks. Major bile duct injuries should be properly characterized by appropriate imaging studies. One should avoid undue haste while opting for surgical interventions which are invariably required for such major injuries. Such repairs should be undertaken by expert hepatobiliary surgeons as the first repair has the greatest chance of success and failed repairs raises the level of injury making subsequent repairs more difficult.