Relaparoscopy in minor bile leakage after laparoscopic cholecystectomy: an alternative approach?

PURPOSE: Bile leakage is one of the most important complications of laparoscopic cholecystectomy, and it has been recognized as a major clinical challenge during the last 2 decades. Although endoscopic and percutaneous interventions are widely accepted in the management of bile leakage, relaparoscopy permits the bile drainage adequately and gives direct control of bile leakage site in selected patients.

METHODS: Data for patients with minor bile leakage after laparoscopic cholecystectomy were collected from January 2001 to January 2010. Patients were categorized in 2 groups, nonoperative and relaparoscopy. Clinical presentation, kind of management, and outcomes were evaluated in 2 groups.

RESULTS: After a total of 2652 laparoscopic cholecystectomies, postoperative minor bile leakage occurred in 17 (0.64%) patients. Four patients with minimal leakage were managed by percutaneous drainage alone. Endoscopic retrograde cholangiopancreatography was applied to 4 patients with jaundice, high output bile fistula, and a patient with retained common bile duct stone. Bile leakage was controlled in 3 of the 4 patients. There were 9 patients in the relaparoscopic group to which 1 patient was added after unsuccessful endoscopic intervention. The source of bile leakage in the relaparoscopic cases was defined as 50% from cystic duct stump and 50% from Luschka or accessory ducts. The success rate of bile leakage control after relaparoscopy was 90%. The mean of hospital stay after relaparoscopy was 3 days (range, 2-10 d) and after endoscopic retrograde cholangiopancreatography intervention or percutaneous drainage was 10 days (range, 3-28 d).

CONCLUSIONS: Relaparoscopy is an effective procedure in the management of minor bile leakage after laparoscopic cholecystectomy and can be an alternative approach in selected situations.