Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecystectomy.

Abstract

Bile leakage in the absence of major ductal injury may occur from the liver bed or from the cystic duct remnant after cholecystectomy. The early limitations of minimally invasive surgery led to reliance on endoscopic methods to manage this complication. However, repeat laparoscopy permits drainage of the bile collection and direct control of the site of leakage in selected situations. Details of 15 patients with bile leakage after laparoscopic cholecystectomy were recorded prospectively and are reviewed. Postoperative bile leakage occurred after 15 (0.8 per cent) of 1779 laparoscopic cholecystectomies. Two patients with bile in drainage fluid had spontaneous resolution. Ten patients with a subvesical duct leak had repeat laparoscopy. The leak was successfully controlled by suturing in eight patients, and by a laparoscopically placed drain in two. One patient required a subsequent laparotomy for a loculated pelvic collection. Three patients had cystic duct stump leakage. This was managed successfully by laparoscopy in one case but required endoscopic management in two. Laparoscopy is useful in the management of minor bile leaks after laparoscopic cholecystectomy. Selection of appropriate patients relies on a characteristic clinical presentation after an otherwise uncomplicated cholecystectomy.