Minimally Invasive Management Of Postoperative Bile Leaks

Objective To evaluate the effects of minimally invasive management of postoperative bile leaks.Methods 41 cases of postoperative bile leaks diagnosed and treated in our hospital from January 1992 to January 2007 were retrospectively reviewed, of which 1 case underwent relaparoscopy; 23 cases were treated by conventional therapy which included abrosia, anti-inflammatory, fluid replacement ,celiac drainage and other conservative methods; and the remaining 17 cases were treated by endoscopic approaches, such as EST, ENBD or EBS.Results Of the 23 cases which underwent conventional therapy, 5 were diagnosed clearly about the site of leakage; 19 were healed and bile leaks stopped in 15～30 days, at an average of 20 days; 4 were operated on after unsuccessful conventional therapy; 1 was complicated by subphrenic abscess and 2 by pulmonary infection. Of the 17 cases treated by endoscopic approaches, 16 were successfully treated and bile leaks stopped in 7～22 days, at an average of 12 days; 1 was operated on after unsuccessful endoscopic management because of the large defect of the common bile duct and the large amount of daily drain; 1 was complicated by acute pancreatitis. All of the 17 cases were diagnosed clearly about the site of leakage. 1 case which underwent relaparoscopy was found leakage from the cystic stump and the leakage was closed by the titanic clip during the operation. The patient discharged 6 days after operation. There was no operation-related complication such as pulmonary infection.SConclusions Minimally invasive management, such as endoscopic approaches and relaparoscopy, is safe and effective to treat the postoperative bile leaks after operation. And endoscopic management also has the advantage of simple, fast recovery, minor invasion, short-timed hospitalization.