Biliary leak after laparoscopic cholecystectomy: incidence and management

Background Biliary leak represents an unusual complication of laparoscopic cholecystectomy (LC). The origin of biliary leak is multifactorial, that may arise from gallbladder bed, cystic duct, or injuries of a major bile duct. Even with standardization and growing experience, LC still involves threat of damage of the biliary tree. The reported incidence of iatrogenic bile duct injuries was 0.3-0.9%. As the occurrence of iatrogenic bile duct injury remains high, it is still a determining factor for morbidity related to LC. Patients and methods This study was a case series of 1000 cases who underwent LC. Twenty cases complaining from biliary leakage following LC had been reported consecutively. The age of patients was 22-57 years and sex was dispensed as 780 females and 220 males. There were five (25%) males and 15 (75%) females in the studied patients. The statistics had been acquired from the cases getting admitted with bile leak following LC or developed bile leak post-LC, had been managed properly, and the follow-up period was 3 months. Results In the current study, there were 20 cases; out of the 1000 patients that underwent LC complaining from biliary leakage, 14 of the 20 patients were presented with bile leakage following LC, which was attributed to gallbladder bed, duct of Luschka, and minor accessory duct, two cases due to unsecure or slipped ligature of the cystic duct, and a slipped clip. Two cases due to injury to common hepatic duct and the other two cases due to direct injury to common bile duct. The definitive treatment of biliary leakage was done. All cases were treated therefore with the use of endoscopy in four cases (plus percutaneous techniques in two patients) and surgical intervention in one patient and one patient died. The endoscopic management proved very effective in cases with simple biliary leakage than patients with complex bile leak. Conclusion Biliary leakage post-LC is an unusual problem. The incidence in most reported studies is much less than 2% and, in the current study, it was precisely 2%. The management of that leakage varies from conservative management, endoscopic retrograde cholangiopancreatography, and insertion of stent and surgical intervention. The long-term prognosis will rely on early diagnosis and successful treatment.