The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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The outcome of endoscopic management of bile leakage after hepatobiliary surgery

  • Yun, Seon Ung (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Cheon, Young Koog (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Shim, Chan Sup (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Lee, Tae Yoon (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Yu, Hyung Min (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Chung, Hyun Ah (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Kwon, Se Woong (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Jeong, Taek Gun (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • An, Sang Hee (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Jeong, Gyung Won (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Kim, Ji Wan (Department of Internal Medicine, Konkuk University School of Medicine)
  • Received : 2015.06.10
  • Accepted : 2016.05.12
  • Published : 2017.01.01
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Abstract

Background/Aims: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. Methods: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. Results: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. Conclusions: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Keywords

Acknowledgement

Supported by : Konkuk University

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