BILE LEAK FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY, A PROSPECTIVE STUDY

Ghadban Al-Ebadi ,Abdulkareem Jabbar

doi:10.33762/bsurg.2019.163871

Abstract

Abdulkareem Jabbar Ghadban Al-Ebadi Consultant General & Laparoscopic Surgeon, MB,ChB, CABS, FACS, SAGES, Al-Sadr Teaching Hospital, Basrah, Iraq. Abstract Bile leakage is a very dangerous condition after laparoscopic cholecystectomy and may lead to fatal complications and serious care should be taken to diagnose the cause as early as possible because it may be sign of bile duct injury which is a major concern to the surgeons as if it is not diagnosed early, it will lead to dangerous complications such as biliary peritonitis, hepatic failure and even death. Early diagnosis is important to decrease morbidity and mortality. This study aimed to determine the incidence of bile leakage, its types of management and the outcome in patients with gall stone who are submitted to laparoscopic cholecystectomy. This prospective study was done in Basrah Al-Sadr Teaching Hospital in a two-year period from October 2013 to October 2015 on 560 patients, they were 378 females and 182 males. All of them have symptomatic gall stones and underwent laparoscopic cholecystectomy. All converted cases to open cholecystectomy were excluded. From the total number of 560 patients, nine patients developed bile leak in early post-operative period, 6 of them have drains and the other three have no drain and they were presented with signs and symptoms of intra-abdominal collection. The causes of leak were: common bile duct (CBD) injury in 2 cases, accessory duct in 3 patients, leak from the gall bladder bed in 3 cases and one case iatrogenic from intra-hepatic drain. All the patients were treated conservatively except the two patients with CBD injury who were treated; one with the aid endoscopic retrograde cholangio-pancreatography (ERCP) and the other by re-exploration. In conclusion, bile leak is a serious complication after laparoscopic cholecystectomy, although it is not common but it is important to identify the site of leak and should be treated urgently especially by drainage to avoid more severe results which may lead to increased morbidity and mortality

Highlights

Laparoscopic surgery is regarded as an effective and safe technique in hepatobiliary surgeries, especially in cholecystectomy which is regarded as a golden standard procedure especially if there is a clear anatomy with no severe adhesions or fibrosis in which open cholecystectomy is more safe, incidence of bile duct injuries is higher in laparoscopic cholecystectomy than in open procedure[1]
In the beginning of laparoscopic cholecystectomy, bile leak was managed by conservative way, if no response, a laparotomy may be done, but with the development of endoscopic retrograde cholangiopancreatography, improvement in laparoscopy skills and suturing techniques, nowadays bile leak management can be performed by minimal invasive technique which in turn leads to less morbidity and mortality[6,7]
The aim of this study is to evaluate the incidence of bile leakage, types of management and the outcome in patients with gall stone who are submitted to laparoscopic cholecystectomy

Summary

Introduction

Laparoscopic surgery is regarded as an effective and safe technique in hepatobiliary surgeries, especially in cholecystectomy which is regarded as a golden standard procedure especially if there is a clear anatomy with no severe adhesions or fibrosis in which open cholecystectomy is more safe, incidence of bile duct injuries is higher in laparoscopic cholecystectomy than in open procedure[1]. Bile leak incidence after laparoscopic cholecystectomy is about 0.3–2.7%, it is not common, but it is important and should be taken seriously because it may be a sign of major duct injury with dangerous complications[3]. Bile leak is a continuous leakage of bile anywhere from biliary tree or liver bed for any reason, the most common cause is slipping of the clips of the cystic duct stump or the stump is not securely closed, other causes may include subvesical duct of luschka[4] or other accessory duct or from gall bladder bed, but the most serious cause of bile leakage is injury of CBD or common hepatic duct which may be partial or complete and can lead to major complications such as subphrenic abscess, biliary fistula, peritonitis and even death[5]. The aim of this study is to evaluate the incidence of bile leakage, types of management and the outcome in patients with gall stone who are submitted to laparoscopic cholecystectomy

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