ENDOSCOPIC MANAGEMENT OF POST-SURGICAL BILIARY LEAKS: OUR EXPERIENCE

Aims:

Biliary leaks (BL) are a relatively common complication after hepatobiliary surgery, whose incidence varies within different patient series, from 0.1 and 3% for cholecystectomy, and up to 15% for hepatectomy. Most of the cases can be solved with twith endoscopic management replacing the need of surgery.

Aims: To show the results of our experience in the endoscopic management of these lesions with endoscopic retrograde cholangiopancreatography (ERCP).

Methods:

Unicentric descriptive retrospective study examining the results of all the patients who underwent an ERCP between 2009 and 2017 due to a BL secondary to cholecystectomy or hepatectomy. A description of the clinical presentation of BL and the effectiveness and complications of ERCP is made. The statistical analysis was performed using SPSS ® version 21.

Results:

38 patients were recruited in this period, with a mean age of 67 years old (range 24 – 90). 17 (44.7%) of the BL were secondary to laparoscopic cholecystectomy; 12 (31.6%), to open cholecystectomy; and 9 (23.7%), to hepatectomy. The most common location (50%) was the cystic duct stump, and 23.7% had unknown location. In 65%, its clinical presentation was early and the main clinical sign (76.3%) was persistence of high biliar drainage. Sphincterotomy was done in 37 patients, with biliar stent implantation in 22 of them, while the remaining case was managed with biliar stent without sphincterotomy. Technical success was achieved in 28 (96.6%) of post-cholecystectomy BL, and in 7 (77.8%) of post-hepatectomy BL; results without statistical significance. 9 complications were reported: 3 stent migrations, 3 post-ECRP pancreatitis and 3 deaths due to multiorganic failure non-related to the endoscopic procedure.

Conclusions:

According to our data, the management of post-surgical biliary leaks by ERCP is effective (endoscopic success rate of 92.1%) and safe, demonstrating better results in those post-cholecystectomy.