Postoperative bile leakage: endoscopic management.

Bile leakage is an infrequent but serious complication after biliary tract surgery. This non-randomised single centre study evaluated the endoscopic management of this problem in 55 consecutive cases. Treatment consisted of standard sphincterotomy and, if needed, subsequent stone extraction with or without endoprosthesis placement. The aim of all treatments was to facilitate bile flow into the duodenum. The biliary tract and the site of the leakage were visualised during endoscopic retrograde cholangiopancreatography (ERCP) in 98%. There was distal obstruction in 33--caused by retained gall stones in 15 patients and concomitant strictures in 18. Overall, 48 of 55 patients were treated endoscopically. An excellent outcome (clinical and radiological resolution of the bile leak) was achieved in 43 patients (90%). Five patients (10%) had continuing sepsis from which they died. Postoperative bile leakage can be diagnosed safely and effectively by ERCP and subsequent endoscopic management is successful in most cases.