Clnical Analysis Of Bile Leakage After Primary Closuer Following Laparoscopic Choledochotomy

Objective: By analyzing the types and reasons of bile leakage after primary closure following laparoscopic choledochotomy, to make the appropriate prevention methods and treatment measures which are foundation for the further development of such operations.Methods: 115 patients received primary closure following laparoscopic choledochotomy in our hospital between January 2005 to October 2009 were reviewed. All cases were documented in detail with patients'general situation, total medical fees, admission day, total bilirubin, serum albumin, transaminase levels, and postoperative abdominal drainage situation, whether the application of somatostatin, acid, antispasmodic therapy, etc. All data were divided into two groups, non-bile leakage and bile leakage, furthermore, bile leakage complications, treatments and prognosis are recorded in detail in bile leakage group.Results: Bile leakage occurred in 10 cases (8.70%), of them only 1 case shows non-obvious symptoms and signs, more than 8 cases show different degrees of fever, abdominal pain, abdominal distention, jaundice and other symptoms; 6 patients underwent conservative treatment, 2 patients take B-puncture fluid, 1 case of surgical exploration re-discovery of the cystic duct remnant stones, 1 case died of severe peritonitis after operation, hypoproteinemia, and so on.Conclusion: The incidences of bile leakage after primary closure following laparoscopic choledochotomy are still high, the main reasons are indications grasped not strictly as well as closure techniques under laparoscopic not skilled. Even though there are bile leakage complications, most patients with conservative treatments are able to be healed, the principles are timely diagnosis and early treatment, prevention and treatment of secondary infections, of them maintaining unobstructed and efficient drainage shall be the key of dealing with bile leakage.