Author/Editor		Koželj, M; Flis, V
Title		Management of bile leaks after laparoscopic cholecistectomy
Type		članek
Source		In: Broelsch CE, Izbicki JR, Bloechle C, et al, editors. European IHPBA congress Hamburg '97; 1997 Jun 8-12; Hamburg. Bologna: Monduzzi editore,
Publication year		1997
Volume		str. 437-41
Language		eng
Abstract		The aim of the present study (1992-1996) was to find out the incidence of bile leake after laparoscopic cholecistectomy and to analyze the clinical course in such cases. In mentioned period 597 cholecystectomies were performed (470 female patients, average 45.1 years, range 16-80). In 6 (1%) patients bile leake (BL) occurred postopeatively. In four cases of BL the problem was detected during the first hospital stay in rest two cases after discharge. One patient was operated urgently. In this case drainage of the subhepatic space was performed and leaking bile duct in liver bed was oversawn. In two cases minimal leakage was detected with ultrasound and both patients were witohout major clinical symptoms. In one of lat cases additional ultrasound (US) guided aspiration was needed. In two cases ERCP and EPT was performed and drainage alone has been done. In one patient common bile duct stone was the reason for the cysticus stump leakage. By last patient laparoscopic exploration was performed on the sixth postoperative day and the biliary collection again drained. However the surgeon didnt find the site of leakage. It is concluded that only two patients (EPT!) were treated along the line with contemporary algorithms. Early diagnosis is imperative, US is the first line of investigation, next step should be ERCP with EPT and surgeon should be very conservative in decisions for early open treatment. Clinical outcome without accurate diagnosis (possible major iatrogenic injury!) is in case of bile leaks unpredictable.
Descriptors		CHOLECYSTECTOMY, LAPAROSCOPIC BILE DUCTS POSTOPERATIVE COMPLICATIONS DRAINAGE