Predisposing Factors Associated with Post Cholecystectomy Bile Leak

Abstract

Introduction: Post cholecystectomy bile leak is an uncommon occurrence, but can have significant consequences. Surgical management has shown to have high morbidity and mortality. Endoscopic management via ERCP with sphincterotomy and biliary stent placement has become the mainstay of therapy at this time. To date, little has been described regarding predisposing factors that can lead to a postoperative bile leak. The aim of this study was to assess post cholecystectomy bile leak and determine if there are predisposing factors associated with them. Methods: This retrospective study evaluated patients who underwent cholecystectomy and were found to have a post cholecystectomy bile leak that was treated with ERCP with sphincterotomy and stent placement done at our single center institute. Data from the ERCP cholangiogram was reviewed and included in the data set, including biliary ductal dilatation, stones or sludge in the biliary tract, biliary stenosis, papillary stenosis, duodenal diverticulum, and duct of Luschka. Results: Thirty one patients (17 females, average age 48.3±1.3) with post cholecystectomy bile leak followed by an ERCP were identified from July 2011 to June 2016. Eighteen of the thirty two (56%) patients had at least one of the findings above. Six patients had stones, one additional patient had sludge but no stones, 3 patients had duodenal diverticulum, 1 with biliary stricture, 2 with papillary stenosis, and 6 with a duct of Luschka. Only 6 of these patients had a dilated CBD, 3 associated with stones, 2 with duodenal diverticulum, and 1 without any other obstructive findings. Conclusion: Post cholecystectomy bile leak is an uncommon occurrence, but often (56% of the time) it is accompanied by a predisposing factor. Retained stones and sludge is the most common cause in our small study followed by a duct of Luschka, and duodenal diverticulum. Care should be taken preoperatively to make sure there are no bile duct stones, sludge, or unexplained dilated common bile duct. Further larger studies are needed to assess the utility of pre surgical imaging as well as better describe predisposing factors.