The outcome of endoscopic management of bile leakage after hepatobiliary surgery
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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.
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.
참고문헌 (23)
- Binmoeller KF, "Endoscopic management of postoperative biliary leaks: review of 77cases and report of two cases with biloma formation", Am J Gastroenterol, 86, pp.227~231 (1991)
- Bjorkman DJ, "Postsurgical bile leaks: endoscopic obliteration of the transpapillary pressure gradient is enough", Am J Gastroenterol, 90, pp.2128~2133 (1995)
- Barkun AN, "Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management. McGill Gallstone Treatment Group", Gastrointest Endosc, 45, pp.277~282 (1997)
- Agarwal N, "Endoscopic management of postoperative bile leaks", Hepatobiliary Pancreat Dis Int, 5, pp.273~277 (2006)
- Davids PH, "Postoperative bile leakage: endoscopic management", Gut, 33, pp.1118~1122 (1992)
- Ijichi M, "Randomized trial of the usefulness of a bile leakage test during hepatic resection", Arch Surg, 135, pp.1395~1400 (2000)
- Lam CM, "Biliary complications during liver resection", World J Surg, 25, pp.1273~1276 (2001)
- Li J, "Intraoperative application of “white test” to reduce postoperative bile leak after major liver resection: results of a prospective cohort study in 137 patients", Langenbecks Arch Surg, 394, pp.1019~1024 (2009)
- Lo CM, "Biliary complications after hepatic resection: risk factors, management, and outcome", Arch Surg, 133, pp.156~161 (1998)
- Nagano Y, "Risk factors and management of bile leakage after hepatic resection", World J Surg, 27, pp.695~698 (2003)
- Pace RF, "Intra-abdominal sepsis after hepatic resection", Ann Surg, 209, pp.302~306 (1989)
- Paquet JC, "Prevention of deep abdominal complications with omentoplasty on the raw surface after hepatic resection: the French Associations for Surgical Research", Am J Surg, 179, pp.103~109 (2000)
- Kaffes AJ, "Impact of endoscopic intervention in 100patients with suspected postcholecystectomy bile leak", Gastrointest Endosc, 61, pp.269~275 (2005)
- Sandha GS, "Endoscopic therapy for bile leak based on a new classification: results in 207 patients", Gastrointest Endosc, 60, pp.567~574 (2004)
- Ryan ME, "Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy:a multicenter review", Gastrointest Endosc, 47, pp.261~266 (1998)
- Dechene A, "Endoscopic management is the treatment of choice for bile leaks after liver resection", Gastrointest Endosc, 80, pp.626~633 (2014)
- Donatelli G, "Combined endoscopic and radiologic approach for complex bile duct injuries (with video)", Gastrointest Endosc, 79, pp.855~864 (2014)
- Marks JM, "Biliary stenting is more effective than sphincterotomy in the resolution of biliary leaks", Surg Endosc, 12, pp.327~330 (1998)
- 김국현, "Endoscopic Management of Bile Leakage after Cholecystectomy:A Single-Center Experience for 12 Years", Clinical Endoscopy, 47(3), pp.248~253 (2014), 대한소화기내시경학회
- Tzovaras G, "Minimally invasive management of bile leak after laparoscopic cholecystectomy", HPB (Oxford), 3, pp.165~168 (2001)
- Peters JH, "Diagnosis and management of bile leaks following laparoscopic cholecystectomy", Surg Laparosc Endosc, 4, pp.163~170 (1994)
- Barton JR, "Management of bile leaks after laparoscopic cholecystectomy", Br J Surg, 82, pp.980~984 (1995)
- Wootton FT, "Biliary complications following laparoscopic cholecystectomy", Gastrointest Endosc, 38, pp.183~185 (1992)