Ji-Hui Li1, Hang-Tao Liu. 1. Minimally Invasive Surgery Center, Shanghai Changhai Hospital, Second Military Medical University, Shanghai 200433, China. jihuilimd@hotmail.com
Abstract
BACKGROUND: Operative complications after laparoscopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the operative area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to evaluate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symptoms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiography and/or endoscopic retrograde cholangiopancreatography. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperation for closure of the opened CD stump can be fulfilled under laparoscopy. Endoscopic drainage must be accompanied with effective abdominal drainage.
BACKGROUND: Operative complications after laparoscopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the operative area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to evaluate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symptoms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiography and/or endoscopic retrograde cholangiopancreatography. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperation for closure of the opened CD stump can be fulfilled under laparoscopy. Endoscopic drainage must be accompanied with effective abdominal drainage.