Abstract Background Bile leak is a frequent complication following laparoscopic total, subtotal cholecystectomy, and bile duct exploration (BDE) with an incidence up to 2.8%. It can contributing significantly to postoperative morbidity and mortality. GTN has demonstrated efficacy in reducing papillary muscle contraction and Sphincter of Oddi pressure. Similarly GTN might promote healing and closure of bile leaks post total or subtotal cholecystectomy. This study aims to assess the safety and effectiveness of GTN in treating bile leaks post total, subtotal cholecystectomy or bile duct exploration. Method Data was prospectively collected from patients who developed bile leaks after total or subtotal cholecystectomy between June 2020 and June 2024. Inclusion criteria were patients with a bile leak post-surgery during this period. Exclusion criteria included unstable patients, uncontrolled bile leaks, the presence of biliary obstruction, or major bile duct injuries. Suitable patients were treated with a GTN patch as first line management before potential ERCP. A 5 mg GTN skin patch was applied every 24 hours, starting at least 48 hours post-surgery if drain output exceeded 100 ml/hour. Patients were consented about side effects including hypotension and headache. Results Seven patients were treated with GTN, with mean age of 51 years, four were females. Four cases were emergencies and four had subtotal cholecystectomies, one in the elective group. Bile leaks occurred after biloma drainage and one after removal of trans-cystic drain post trans-cystic BDE. All patients experienced significant drain output reduction the day after starting GTN. There were no complications during or after treatment. One required ERCP two months later for persistent low-volume bile leak of 5-10 ml per day. Headaches occurred in two cases, treatment was discontinued in one. The average time to GTN treatment was 3.4 days. Conclusion This study demonstrates GTN treatment's safety and effectiveness for managing bile leaks following total, subtotal cholecystectomy or BDE. We recommend GTN as the primary therapy for controlled bile leaks, barring biliary obstruction or major injury. Response can be evaluated within 24-48 hours through significant output reduction. Implementing local protocols can minimize variations in GTN treatment initiation times. GTN should be prioritized over ERCP to prevent complications like perforation, pancreatitis, and bleeding. We aim for this study to underscore GTN's efficacy to surgeons and promote multicentre research initiatives.
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