Bile leakage from subvesical bile duct (duct of Luschka) after laparoscopic cholecystectomy

Abstract

Bile leakage is a serious complication in laparoscopic cholecystectomy. Subvesical bile duct (duct of Luschka) injury is a secondary major cause of bile duct injury after laparoscopic cholecystectomy. Between January 2019 and December 2020, we performed 1,269 laparoscopic cholecystectomies in our department. There were 4 cases (0.3%) of subvesical bile duct injury. 1 case was found during operation, the other 3 cases developed abdominal pain after postoperative 3th or 7th days. In the intra-operative case, the injured duct was closed with endo-clip. There was no post-operative complication. Postoperatively found cases were treated with endoscopic retrograde cholagiopanreatography (ERCP). However, ERCP failed (2), continuous bile leak and abdominal pain (1) developed. Re-laparoscopy (2) and explo-laparotomy (1) performed. During operation, meticulous observation of the gallbladder fossa should be performed after cholecystectomy. If bile leak has found post-operatively, ERCP with biliary stenting is effective. If ERCP fails, surgical treatments required. A surgeon should be aware of this anomaly of the bile duct and know about the prevention and the managements.