Immediate post operative management of Bile leak following laparoscopic or open cholecystectomy – Tertiary care centre in South India
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 11
Abstract
Introduction: The most common cause of bile duct injuries are Iatrogenic. Cholecystectomy related bile duct injuries are disastrous both healthwise and monetarily. There is no clear algorithm for early management of bile duct injuries using various percutaneous, endoscopic and surgical approaches. Aim, Materials and Methods: The aim of the study was to define the role of various approaches i.e percutaneous, endoscopic, laparoscopic and open surgical drainages in the early management of bile duct injuries. We retrospectively analysed 104 patients with bile duct injuries following cholecystectomies referred to and treated in our Institute between July 2012 and January 2017. Patients underwent drainage of the biliary collections by various means including percutaneous (n=47), endoscopic (n=26), laparoscopic and open surgical approaches (n=22) depending upon their clinical condition. Analysis of the outcomes of the various approaches for the early management of bile duct injuries was done using simple descriptive statistics. Results: Most of the biliary injuries occurred following laparoscopic cholecystectomy (66.4%). There was a female (58.65%) predominance and most of the patients were in the age group of 20 to 49 (n=65; 62.8%). The most common type of biliary injuries were cystic duct stump leak (n=47; 45.2%) followed by type E1 (n=23; 22.1%), type E2 (n=13; 12.5%) and type E3 (n=10; 9.6%). Of the 104 patients, 43 (41.35%) were referred within 7 days of index surgery of which 38 (88.37%) had bilioma, 3 (6.97%) presented with jaundice and 3 (6.97%) with features of sepsis. They had a hospital stay ranging between 7 to 14 days. On the other hand, 61 patients (58.65%) were referred beyond 7 days of which 57 (93.4%) had bilioma, 9 (14.8%) presented with sepsis and 8 (12.1%) patients with jaundice and this group had a hospital stay ranging from 50-90 days. While the 9 patients who had no bilioma on imaging and no sepsis were managed conservatively, the rest underwent some form of intervention. The majority (n=47; 45.2%) underwent PCD insertion. 26 (25%) patients underwent ERCP with stenting while 22 (21.2%) underwent surgical drainage. The overall success rate of ERCP was 52% and was specifically useful in cases with cystic duct stump leak (success rate 83.3%). ERCP was associated with complications like bleeding in two, cholangitis in three and pancreatitis in two patients. Conclusion: Acute BDI should be managed at a tertiary care referral centre where multidisciplinary facilities including expertise in diagnostic, percutaneous radiological interventions and endoscopic and laparoscopic facilities are available. Early identification and referral is a key to reduced morbidity.
Authors and Affiliations
Villalan Ramasamy, Rajasekaran karuppiah, Amarjothi JMV, Srinivasan muthukrishnan, Prabhakaran . R, Rajendran . S, NaganathBabu . O. L
Keywords
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- DOI 10.9790/0853-1711061923.
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