Hoda Haidar1, Elias Manasa2, Kamel Yassin1, Alain Suissa3, Yoram Kluger1,2, Iyad Khamaysi4,5. 1. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, POB 9602, 31096, Haifa, Israel. 2. Department of Surgery, Rambam Medical Center, Haifa, Israel. 3. Invasive Endoscopy Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel. 4. The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, POB 9602, 31096, Haifa, Israel. k_iyad@rambam.health.gov.il. 5. Invasive Endoscopy Unit, Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel. k_iyad@rambam.health.gov.il.
Abstract
BACKGROUND: Post-cholecystectomy bile leak is relatively a well-known surgical complication. Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data. However, there is no consensus as to the optimal endoscopic intervention. METHODS: A retrospective review of ERCP database was done to identify all cases of bile leak related to cholecystectomy. Patient records including surgical and endoscopic reports were reviewed, and telephone interviews were conducted to collect data. RESULTS: During the period 2004-2016, 100 patients (53 men, 47 women; mean age, 55 years) with post-cholecystectomy bile leak were referred for ERCP. Cholecystectomy was done laparoscopically in 82 patients (with an open conversion rate of 13%). In the majority of cases (77%), the leak was diagnosed by ongoing bile flow from the drains. The most common symptoms were pain (17%) and fever (4%). The most common site of the leak was the cystic duct stump (79%) followed by subvesical ducts (7%). Low grade leaks were seen in 84% of cases. Treatment included stent insertion alone (9%), sphincterotomy alone (11%), combination stent/sphincterotomy (76%) and others (1%). Failed ERCP was encountered in 3%. Endoscopic therapy was successful in 90 patients (90%). In subgroup analysis, success rate of procedures with stent insertion (with or without sphincterotomy) is significantly higher compared to procedures without stent insertion (95.3% vs 72.7%, p < 0.05). The failure rate of sphincterotomy alone procedures (3/11, 27%) is much higher compared to procedures with stent insertion (4/85, 5%) with p < 0.05. Four patients (4%) developed post-ERCP pancreatitis (mild to moderate) and one patient (1%) suffered from retroperitoneal perforation. CONCLUSION: The optimal endoscopic intervention for post-cholecystectomy bile leak should include temporary insertion of a biliary stent.
BACKGROUND: Post-cholecystectomy bile leak is relatively a well-known surgical complication. Several potential treatment modalities for such leaks are used. The early use of ERCP to exclude significant bile duct injury and to treat the leak by various endoscopic means is supported by a large bulk of data. However, there is no consensus as to the optimal endoscopic intervention. METHODS: A retrospective review of ERCP database was done to identify all cases of bile leak related to cholecystectomy. Patient records including surgical and endoscopic reports were reviewed, and telephone interviews were conducted to collect data. RESULTS: During the period 2004-2016, 100 patients (53 men, 47 women; mean age, 55 years) with post-cholecystectomy bile leak were referred for ERCP. Cholecystectomy was done laparoscopically in 82 patients (with an open conversion rate of 13%). In the majority of cases (77%), the leak was diagnosed by ongoing bile flow from the drains. The most common symptoms were pain (17%) and fever (4%). The most common site of the leak was the cystic duct stump (79%) followed by subvesical ducts (7%). Low grade leaks were seen in 84% of cases. Treatment included stent insertion alone (9%), sphincterotomy alone (11%), combination stent/sphincterotomy (76%) and others (1%). Failed ERCP was encountered in 3%. Endoscopic therapy was successful in 90 patients (90%). In subgroup analysis, success rate of procedures with stent insertion (with or without sphincterotomy) is significantly higher compared to procedures without stent insertion (95.3% vs 72.7%, p < 0.05). The failure rate of sphincterotomy alone procedures (3/11, 27%) is much higher compared to procedures with stent insertion (4/85, 5%) with p < 0.05. Four patients (4%) developed post-ERCP pancreatitis (mild to moderate) and one patient (1%) suffered from retroperitoneal perforation. CONCLUSION: The optimal endoscopic intervention for post-cholecystectomy bile leak should include temporary insertion of a biliary stent.
Authors: D J Bjorkman; D L Carr-Locke; D R Lichtenstein; A P Ferrari; A Slivka; J Van Dam; D C Brooks Journal: Am J Gastroenterol Date: 1995-12 Impact factor: 10.864
Authors: Victor Lopez-Lopez; Javier Maupoey; Rafael López-Andujar; Emilio Ramos; Kristel Mils; Pedro Antonio Martinez; Andres Valdivieso; Marina Garcés-Albir; Luis Sabater; Luis Díez Valladares; Sergio Annese Pérez; Benito Flores; Roberto Brusadin; Asunción López Conesa; Valentin Cayuela; Sagrario Martinez Cortijo; Sandra Paterna; Alejando Serrablo; Santiago Sánchez-Cabús; Antonio González Gil; Jose Antonio González Masía; Carmelo Loinaz; Jose Luis Lucena; Patricia Pastor; Cristina Garcia-Zamora; Alicia Calero; Juan Valiente; Antonio Minguillon; Fernando Rotellar; Jose Manuel Ramia; Cándido Alcazar; Javier Aguilo; Jose Cutillas; Christoph Kuemmerli; Jose A Ruiperez-Valiente; Ricardo Robles-Campos Journal: J Gastrointest Surg Date: 2022-07-05 Impact factor: 3.267