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Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل


Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.

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