Delayed Bile Leakage after Laparoscopic Cholecystectomy:Report of 12 Cases
- VernacularTitle:腹腔镜胆囊切除术后迟发性胆漏12例报告
- Author:
Yong CHEN
;
Ying XI
;
Jinlong LI
- Publication Type:Journal Article
- Keywords:
Laparoscopic cholecystectomy;
Delayed bile leakage;
Electrothermal effect
- From:
Chinese Journal of Minimally Invasive Surgery
2005;0(11):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To Discuss the causes,prevention and treatment of delayed bile leakage following laparoscopic cholecystectomy (LC). Methods From November 1994 to December 2007,totally 11 000 cases of LC were performed in our hospital,12 of them developed delayed bile leakage after the procedure. The mechanism,characteristics,treatment,and prognosis of the disease were analyzed retrospectively. Results Among the twelve cases of delayed bile leakage,eight cases showed perforation of the bile duct caused by thermoelectric effect,two cases had leakage of the aberrant bile-duct,and two cases were injured by unknown reasons. B-ultrasonography-guided drainage was performed in four of the patients,laparoscopic or open repair combined with T-tube drainage were carried out in three,abdominal puncture combined with endoscopic nasobiliary drainage (ENBD) was done in three,abdominal puncture with endoscopic retrograde biliary drainage (ERBD) was made in one,and open repair and bilio-jejunal anastomosis was performed in one. All patients were cured and discharged in 8 to 21 days with a mean of 15 days. No intra-abdominal infection,hemorrhage,recurrent bile leakage or intestinal leakage occurred after the operations. Re-examination by B-ultrasonography or cholangiopancreatography performed ten days after the drainage showed no stricture or dilation of the bile duct,and contrast media drained out fluently. The 12 cases were followed up for one year,none of them showed biliary stenosis or infections during the period. Conclusions Post-LC injury of the bile duct is mostly caused by thermoelectric effect. Gentle operation and separation strictly following the anatomical levels are the keys in prevention of postoperative delayed bile leakage; while endoscopy and interventional treatment are main methods for the diagnosis and treatment of the disease.
