Skip to main content
PMC home page
Gut logoLink to Gut
. 1992 Aug;33(8):1118–1122. doi: 10.1136/gut.33.8.1118

Postoperative bile leakage: endoscopic management.

P H Davids 1, E A Rauws 1, G N Tytgat 1, K Huibregtse 1
PMCID: PMC1379454  PMID: 1398239

Abstract

Bile leakage is an infrequent but serious complication after biliary tract surgery. This non-randomised single centre study evaluated the endoscopic management of this problem in 55 consecutive cases. Treatment consisted of standard sphincterotomy and, if needed, subsequent stone extraction with or without endoprosthesis placement. The aim of all treatments was to facilitate bile flow into the duodenum. The biliary tract and the site of the leakage were visualised during endoscopic retrograde cholangiopancreatography (ERCP) in 98%. There was distal obstruction in 33--caused by retained gall stones in 15 patients and concomitant strictures in 18. Overall, 48 of 55 patients were treated endoscopically. An excellent outcome (clinical and radiological resolution of the bile leak) was achieved in 43 patients (90%). Five patients (10%) had continuing sepsis from which they died. Postoperative bile leakage can be diagnosed safely and effectively by ERCP and subsequent endoscopic management is successful in most cases.

Full text

PDF
1118

Images in this article

1119Figure 1
on p.1119
1119Figure 2
on p.1119
1120Figure 3
on p.1120
1120Figure 4
on p.1120

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrén-Sandberg A., Johansson S., Bengmark S. Accidental lesions of the common bile duct at cholecystectomy. II. Results of treatment. Ann Surg. 1985 Apr;201(4):452–455. doi: 10.1097/00000658-198504000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Binmoeller K. F., Katon R. M., Shneidman R. Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol. 1991 Feb;86(2):227–231. [PubMed] [Google Scholar]
  3. Cotton P. B., Baillie J., Pappas T. N., Meyers W. S. Laparoscopic cholecystectomy and the biliary endoscopist. Gastrointest Endosc. 1991 Jan-Feb;37(1):94–97. doi: 10.1016/s0016-5107(91)70637-8. [DOI] [PubMed] [Google Scholar]
  4. Del Olmo L., Meroño E., Moreira V. F., García T., García-Plaza A. Successful treatment of postoperative external biliary fistulas by endoscopic sphincterotomy. Gastrointest Endosc. 1988 Jul-Aug;34(4):307–309. doi: 10.1016/s0016-5107(88)71361-9. [DOI] [PubMed] [Google Scholar]
  5. Glenn F. Iatrogenic injuries to the biliary ductal system. Surg Gynecol Obstet. 1978 Mar;146(3):430–434. [PubMed] [Google Scholar]
  6. Goldman G., Leviav A., Mazor A., Kashtan H., Aladgem D., Greenstein A., Wiznitzer T. Alpha-adrenergic blocker for posthernioplasty urinary retention. Prevention and treatment. Arch Surg. 1988 Jan;123(1):35–36. doi: 10.1001/archsurg.1988.01400250037005. [DOI] [PubMed] [Google Scholar]
  7. Grace P. A., Poston G. J., Williamson R. C. Biliary motility. Gut. 1990 May;31(5):571–582. doi: 10.1136/gut.31.5.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Granelli P., Angelini G. P., Tambussi A. M., Nicolini A., Celli L. Tubular duplication of the oesophagus in a child: clinical, radiologic and endoscopic features. Endoscopy. 1983 Jul;15(4):263–265. doi: 10.1055/s-2007-1021528. [DOI] [PubMed] [Google Scholar]
  9. Huibregtse K., Katon R. M., Coene P. P., Tytgat G. N. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986 Oct;32(5):334–338. doi: 10.1016/s0016-5107(86)71878-6. [DOI] [PubMed] [Google Scholar]
  10. Huibregtse K., Katon R. M., Tytgat G. N. Endoscopic treatment of postoperative biliary strictures. Endoscopy. 1986 Jul;18(4):133–137. doi: 10.1055/s-2007-1018353. [DOI] [PubMed] [Google Scholar]
  11. Huibregtse K., Tytgat G. N. Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut. 1982 May;23(5):371–375. doi: 10.1136/gut.23.5.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Martin J. K., Jr, van Heerden J. A. Surgery of the liver, biliary tract, and pancreas. Mayo Clin Proc. 1980 May;55(5):333–337. [PubMed] [Google Scholar]
  13. McSherry C. K., Glenn F. The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg. 1980 Mar;191(3):271–275. doi: 10.1097/00000658-198003000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ponchon T., Gallez J. F., Valette P. J., Chavaillon A., Bory R. Endoscopic treatment of biliary tract fistulas. Gastrointest Endosc. 1989 Nov-Dec;35(6):490–498. doi: 10.1016/s0016-5107(89)72896-0. [DOI] [PubMed] [Google Scholar]
  15. Raute M., Schaupp W. Iatrogene Schäden an den Gallenwegen infolge Cholecystektomie. Behandlung und Ergebnisse. Langenbecks Arch Chir. 1988;373(6):345–354. doi: 10.1007/BF01272553. [DOI] [PubMed] [Google Scholar]
  16. Sauerbruch T., Weinzierl M., Holl J., Pratschke E. Treatment of postoperative bile fistulas by internal endoscopic biliary drainage. Gastroenterology. 1986 Jun;90(6):1998–2003. doi: 10.1016/0016-5085(86)90273-8. [DOI] [PubMed] [Google Scholar]
  17. Siegel J. H., Harding G. T., Chateau F. Endoscopic decompression and drainage of benign and malignant biliary obstruction. Gastrointest Endosc. 1982 May;28(2):79–82. doi: 10.1016/s0016-5107(82)73004-4. [DOI] [PubMed] [Google Scholar]
  18. Smith A. C., Schapiro R. H., Kelsey P. B., Warshaw A. L. Successful treatment of nonhealing biliary-cutaneous fistulas with biliary stents. Gastroenterology. 1986 Mar;90(3):764–769. doi: 10.1016/0016-5085(86)91136-4. [DOI] [PubMed] [Google Scholar]
  19. Speer A. G., Cotton P. B., Russell R. C., Mason R. R., Hatfield A. R., Leung J. W., MacRae K. D., Houghton J., Lennon C. A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987 Jul 11;2(8550):57–62. doi: 10.1016/s0140-6736(87)92733-4. [DOI] [PubMed] [Google Scholar]
  20. Zuidema G. D., Cameron J. L., Sitzmann J. V., Kadir S., Smith G. W., Kaufman S. L., White R. I., Jr Percutaneous transhepatic management of complex biliary problems. Ann Surg. 1983 May;197(5):584–593. doi: 10.1097/00000658-198305000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. vanSonnenberg E., Casola G., Wittich G. R., Christensen R., Varney R. R., Neff C. C., D'Agostino H. B., Moossa A. R. The role of interventional radiology for complications of cholecystectomy. Surgery. 1990 Jun;107(6):632–638. [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES