Retrospective Analysis Of Endoscopic Treatment Of Biliary Leakage After Hepatobiliary Surgery

Objective: To analyze the effect of endoscopic treatment of biliary leakage after hepatobiliary surgery,and to provide reference for the endoscopic treatment of biliary leakage.Methods: Retrospective analysis was performed on a total of 31 patients receiving endoscopic treatment for bile leakage after surgery for hepatobiliary diseases admitted to the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University from January 2015 to December 2019.Each patient's clinical characteristics,treatment,and surgery-related complications were recorded and followed up.Results: A total of 31 patients with bile leakage after hepatobiliary surgery were included in this study,including 12 males(38.7%)and 19 females(61.3%).The most common clinical manifestation of bile leakage in this study was abdominal pain,followed by bile from abdominal drainage tube,abdominal distension,fever,jaundice,nausea and vomiting.Among the 31 patients,9 patients had abdominal effusion,and b-ultrasound-guided abdominal puncture and drainage was performed prior to endoscopic treatment.About endoscopic treatment: In 21 patients with bile leakage alone,8 patients with low-grade biliary leakage underwent endoscopic nasobiliary drainage(ENBD),and 2patient with low-grade biliary leakage underwent endoscopic sphincterotomy(EST)+ENBD due to difficulty in intubation of nasal bile duct.Endoscopic EST+ENBD was performed in 8 patients with high-grade biliary leakage,ENBD alone was performed in 1 patient with high-grade biliary leakage.One patient with complicated biliary leakage underwent endoscopic placement of fully covered self-expanding metal stents(FCSEMS)+ENBD,and one patient with complicated biliary leakage failed endoscopic treatment and underwent exploratory laparotomy.In 3 patients with bile leakage combined bile duct stricture,2 cases of patients with endoscopic accept FCSEMS placement + ENBD,1 case of patients with endoscopic first EST + ENBD,postoperative nasal bile duct dislocation,and then underwent continuous endoscopic retrograde biliary drainage(ERBD)in our hospital;EST+ENBD+ biliary duct lithotomy was performed on all 7 patients with biliary leakage and bile duct stones under endoscopy.The overall success rate of endoscopic treatment of bile leakage after hepatobiliary surgery was 96.8%.All patients were followed up,with a median follow-up time of 117 days.During the follow-up period,all patients had no recurrence of biliary leakage or other complications,1 patient died of gallbladder cancer,and 1 patient died of diseases other than biliary leakage.Conclusion:1.Endoscopic treatment of bile leakage after hepatobiliary surgery is a safe and effective method.2.For patients with simple biliary leakage,ENBD treatment was performed under endoscopy for low-grade biliary leakage,and EST treatment was performed in combination with difficult nasobiliary duct intubation.High grade bile leakage was treated with EST+ENBD under endoscope.3.For patients with complex biliary leakage or biliary leakage combined with bile duct stenosis,FCSEMS +ENBD were used under endoscopy.4.For patients with biliary leakage combined with bile duct stones,EST+ENBD+ biliary duct lithotomy was performed under the endoscope.