Summary
The incidence of bile leaks has increased with laparoscopic cholecystectomy as compared with open cholecystectomy. Minor bile leaks are not infrequent but are clinically insignificant; of the major bile leaks the most common sequela is the biloma, the most serious, bile peritonitis. Early symptoms may be very subtle; all untoward symptoms should be investigated with a HIDA scan to rule out bile leakage. Positive HIDA scans should be followed with endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC). Management of the leakage depends on identification of its source. Prompt identification of ductal injuries permits earlier effective treatment and consequently less morbidity and/or mortality.
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References
Ackerman NB, Sillin LF, Suresh K (1985) Consequences of intraperitoneal bile: bile ascites versus bile peritonitis. Am J Surg 149: 244–246
Andersson R, Tranberg KG, Bengmark S (1990) Roles of bile and bacteria in biliary peritonitis. Br J Surg 77: 36–39
Andersson R, Willen R, Massa G, Transberg KG, Carlen B, Bengmark S (1990) Effect of bile on peritoneal morphology in Escherichia coli peritonitis. Scand J Gastroenterol 25: 405–411
Barthel JS, Sastri SV, Landsbaum C (1989) Closure of cystic duct stump leak by nosobiliary tube drainage. J Clin Gastroenterol 11: 574–577
Binmoeller KF, Katon RM, Shneidman R (1991) Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma. Am J Gastroenterol 86: 227–231
Bismuth H. Personal communication.
Brough WA, Hennessy O, Ewing H, Kune GA (1988) Percutaneous drainage of subphrenic biliary collections using a Ring-McLean sump catheter. Aust NZJ Surg 58: 579–581
Cohn I (1985) Bile peritonitis. In: Berk JE (ed) Bockus gastroenterology. W. B. Saunders, Philadelphia, 6: 3808–3814
Conn JH, Chavez CM, Fain WR. Bile peritonitis: an experimental and clinical study. Am Surg 36:219–224
Corbett CRR, Fyfe NCM, Nicholls RJ, Jackson BT (1986) Bile peritonitis after removal of T-tubes from the common bile duct. Br J Surg 73: 641–643
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidi H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161: 385–387
Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME, Newman GE, Cotton PB, Meyers WC (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215: 196–202
Elboim CM, Goldman L, Hann L, Palestrant AM, Silen W (1983) Significance of post-cholecystectomy subhepatic fluid collections. Ann Surg 198: 137–141
Estrada WN, Zanzi I, Ward R, Negrin JA, Margouleff D (1991) Scintigraphic evaluation of postoperative complications of laparoscopic cholecystectomy. J Nucl Med 32: 1910–1911
Gelman R, Alexander MS, Zucker KA, Bailey RW (1991) The use of radionuclide imaging in the evaluation of suspected biliary damage during laparoscopic cholecystectomy. Gastrointest Radiol 16: 201–204
Gilsdorf JR, Phillips M, McLeod MK, Harness JK, Hoverstein GH, Woodbury D, Daley K (1986) Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy. Am J Surg 151: 259–262
Gould L, Patel A (1970) Ultrasound detection of extrahepatic encapsulated bile: “Biloma.” AJR 132: 1014–1015
Janardhanan R, Brodmerkel GJ, Turowkski P, Gregory DH, Agrawal RM (1986) Endoscopic retrograde cholangiopancreatography in the diagnosis and management of postcholecystectomy cystic duct leaks. Am J Gastroenterol 81: 474–476
Kaufman SL, Kadir S, Mitchell SE, Chang R, Kinnison ML, Cameron JL, White RI (1985) Percutaneous transhepatic biliary drainage for bile leaks and fistulas. AJR 144: 1055–1058
Kozarek R, Gannan R, Baerg R, Wagonfeld J, Ball T (1992) Bile leak after laparoscopic cholecystectomy. Arch Intern Med 152: 1040–1043
Kozarek RA, Traverso LW (1991) Endoscopic stent placement for cystic duct leak after laparoscopic cholecystectomy. Gastrointest Endosc 37: 71–73
Kuligowska E, Schlesinger A, Miller KB, Lee VW, Grosso D (1983) Bilomas: a new approach to the diagnosis and treatment. Gastrointest Radiol 8: 237–243
McAneny DB, Gibran NS, Braasch JW (1991) Novel approach to iatrogenic bile peritonitis. Surgery 109: 796–798
Miles RM, Jeck HS (1953) Observations on experimental bile peritonitis. Surgery 34: 445–456
Moosa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H (1992) Laparoscopic injuries to the bile duct. Ann Surg 215: 203–208
Morgenstern L, Wong L, Berci G (1992) Twelve hundred open cholecystectomies before the laparoscopic era: a standard for comparison. Arch Surg 127: 400–403
Mueller PR, Ferrucci JT, Simeone JF, Cronan JJ, Wittenberg J, Neff CC, Sonnenberg E (1983) Detection and drainage of bilomas: special considerations. AJR 140: 715–720
Nagel CE, Fink-Bennett D, Freitas JE (1985) Bile ascites in adults: diagnosis using hepatobiliary scintigraphy and paracentesis. Clin Nucl Med 10: 403–405
Palestrant AM, Vine HS, Sacks BA, Weinstein M, Ellison H (1983) Nonoperative drainage of fluid collections following operations on the biliary tract. Surg Gynecol Obstet 156: 305–309
Ponsky JL (1991) Complications of laparoscopic cholecystectomy. Am J Surg 161: 393–395
Rayter Z, Tonge C, Bennett CE, Robinson PS, Thomas MH (1989) Bile leaks after simple cholecystectomy. Br J Surg 76: 1046–1048
Rosato EF, Berkowitz HD, Roberts B (1970) Bile ascites. Surg Gynecol Obstet 130: 494–496
Santschi DR, Huizenga KA, Scudamore HH, Dearing WH, Waugh JM (1963) Bile ascites. Am J Surg 87: 851–856
Siddiqui AR, Ellis JH, Madura JA (1986) Different patterns for bile leakage following cholecystectomy demonstrated by hepatobiliary imaging. Clin Nucl Med 11: 751–753
Singh RP (1972) Bile peritonitis after cholecystectomy. Int Surg 57: 651–653
Toriumi D, Ruchim M, Goldber M, Velasco J, Silver J, Berkowitz G, Atlas B (1989) Transnasal biliary drainage for treatment of common bile duct leakage and bile peritonitis. Dig Dis Sci 34: 315–319
Vazquez JL, Thorsen MK, Dodds WJ, Quiroz FA, Martinez ML, Lawson TL, Steward ET, Foley WD (1985) Evaluation and treatment of intraabdominal bilomas. AJR 144: 933–938
Vujic I, Brock JG (1982) Biloma: aspiration for diagnosis and treatment. Gastrointest Radiol 7: 251–254
Walker AT, Shapiro AW, Brooks DC, Braver JM, Tumeh SS (1992) Bile duct disruption and biloma after laparoscopic cholecystectomy: imaging evaluation. AJR 158: 785–789
Weissmann HS, Byun KJC, Freeman LM (1983) Role of Tc-99m IDA scintigraphy in the evaluation of hepatobiliary trauma. Semin Nucl Med 13: 199–222
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Morgenstern, L., Berci, G. & Pasternak, E.H. Bile leakage after biliary tract surgery. Surg Endosc 7, 432–438 (1993). https://doi.org/10.1007/BF00311738
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DOI: https://doi.org/10.1007/BF00311738