Study of post cholecystectomy biliary leakage and its management

Background: Cholecystectomy is one of the most frequently performed surgeries. The surgery is associated with many avoidable complications and hence requires a serious and cautious approach. Aim: The aim of this study was to know the outcome of post cholecystectomy biliary leaks and its management methods. Materials and methods: 10 cases of biliary leaks were studied from 100 open cholecystectomies and 100 laparoscopic cholecystectomies from 2013 January to 2014 January. Pre-operative workup with ultrasound abdomen, LFT and other biochemical investigations were done and diagnosis was established. The outcome of surgery and its most common post-operative complication - biliary leak was studied with following parameters: Post-operative diagnosis, Surgery - Lap or Open, Incision, Method of approach – Fundus or Classical method, CBD exploration, Intra-operative findings, Drains used, Post-operative symptoms, Amount of collections, Removal of drains, USG – Sub hepatic collections, ERCP etc. Results: In the present study of 10 cases, fundus first method was done in 3 cases of open cholecystectomies and none in laparoscopic cholecystectomies. Classical procedure was done in 7 cases out of which 3 cases were done in laparoscopy method and 16 cases in open method. Intra-operative detection of bile duct injury is noted in 3 cases of open cholecystectomies and non in laparoscopic method. In the present study, 56 % of the patients were treated conservatively who required no therapy and surgical placement of the drain itself was sufficient. Conclusion: Pain abdomen, Jaundice, Nausea and Vomiting are the major complaints in case of bile leaks and fistulas. Pathologically, chronic cholecystitis is commonest cause of leaks after surgery mainly because of fibrosis at calots triangle. Incidence of Post-operative bile leaks is almost the same in open and laparoscopic cholecystectomy. Routine placement of drains is must because it permits post operative evacuation of serosanguineous exudates and monitoring of bleeding or leakage of bile. Abdominal collections, bilomas or sub-hepatic abscess are reported less with the placement of drains.