OBJECTIVES: To describe a series of patients who have had cystic duct stump leaks (CDSLs) after laparoscopic cholecystectomy and to compare the current presentation and management with that in previous studies. DESIGN: Two-institution retrospective case series and review of the previously published literature. SETTING: Two teaching hospitals. PATIENTS: Twelve patients who had CDSLs of 5751 patients who underwent total laparoscopic cholecystectomy. MAIN OUTCOME MEASURES: Symptoms at presentation, laboratory values, imaging modalities, treatment modalities, and operative indications and techniques. RESULTS: Between January 1, 1998, and March 31, 2007, 12 patients (0.21%) developed CDSLs a mean of 2.3 days postoperatively. Five patients (42%) were reported to have abnormal cystic ducts. A mean of 3 surgical clips were used for closure. Abdominal pain (58%) was the most common presenting symptom; 9 patients (75%) had an elevated white blood cell count, and 9 (75%) had abnormal liver function test results. Ten patients (83%) underwent endoscopic retrograde cholangiopancreatography (ERCP), and 8 (67%) were definitively treated with ERCP stenting of the common bile duct. Two patients (17%) required adjunctive computed tomography-guided drainage. There was 1 death. CONCLUSIONS: A CDSL can occur for a variety of reasons. Any patient with a postoperative picture consistent with a bile leak should undergo ERCP. If a CDSL is discovered, the common bile duct should be stented. Computed tomography-guided drainage is indicated if the patient does not improve after ERCP. Operative intervention should be reserved for the most serious of circumstances.
OBJECTIVES: To describe a series of patients who have had cystic duct stump leaks (CDSLs) after laparoscopic cholecystectomy and to compare the current presentation and management with that in previous studies. DESIGN: Two-institution retrospective case series and review of the previously published literature. SETTING: Two teaching hospitals. PATIENTS: Twelve patients who had CDSLs of 5751 patients who underwent total laparoscopic cholecystectomy. MAIN OUTCOME MEASURES: Symptoms at presentation, laboratory values, imaging modalities, treatment modalities, and operative indications and techniques. RESULTS: Between January 1, 1998, and March 31, 2007, 12 patients (0.21%) developed CDSLs a mean of 2.3 days postoperatively. Five patients (42%) were reported to have abnormal cystic ducts. A mean of 3 surgical clips were used for closure. Abdominal pain (58%) was the most common presenting symptom; 9 patients (75%) had an elevated white blood cell count, and 9 (75%) had abnormal liver function test results. Ten patients (83%) underwent endoscopic retrograde cholangiopancreatography (ERCP), and 8 (67%) were definitively treated with ERCP stenting of the common bile duct. Two patients (17%) required adjunctive computed tomography-guided drainage. There was 1 death. CONCLUSIONS: A CDSL can occur for a variety of reasons. Any patient with a postoperative picture consistent with a bile leak should undergo ERCP. If a CDSL is discovered, the common bile duct should be stented. Computed tomography-guided drainage is indicated if the patient does not improve after ERCP. Operative intervention should be reserved for the most serious of circumstances.
Authors: Chris Edwards; Alan Bradshaw; Paul Ahearne; Pierre Dematos; Ted Humble; Randy Johnson; David Mauterer; Peeter Soosaar Journal: Surg Endosc Date: 2010-03-03 Impact factor: 4.584
Authors: Craig S Brown; Mamadou Sanogo; Arpan Patel; Allison R Schulman; Krishnan Raghavendran; Patrick E Georgoff Journal: ACG Case Rep J Date: 2019-08-23
Authors: Florian Aspart; Jon L Bolmgren; Joël L Lavanchy; Guido Beldi; Michael S Woods; Nicolas Padoy; Enes Hosgor Journal: Int J Comput Assist Radiol Surg Date: 2021-07-23 Impact factor: 2.924