Objective
The aim was to investigate cases of postlaparoscopic cholecystectomy (LC) bile
leakage and aim to check if endoscopic retrograde cholangiopancreatography
(ERCP) is mandatory for every patient or only for selected cases.
Patients and methods
The present study includes 35 patients who had a bile leak following LC and
subjected to conservative (nonoperative) management and had a patent biliary tree
and normal anatomy in the magnetic resonance cholangiopancreatography
(MRCP) study. Patients were distributed into two groups. Group A included 20
patients who did not undergo an ERCP, while the second group included 15
patients who underwent an ERCP from the start. The efficacy and outcomes of
both lines of management and the time needed to fistula closure were studied. Data
were collected, recorded, and statistically analyzed.
The results
In group A, conservative management succeeded in 18/20 of patients, while the
remaining two patients were sent to undergo ERCP due to a distressing bile
leakage after a time of conservative management. In group B, the first ERCP
failed to help in the cessation of bile leak in 2/15 patients (13%), so they underwent a
second ERCP. The mean hospital stay was higher (but not significant) in the nonERCP group, 5.19±4.72 vs 4.88±3.41 days in the ERCP group. The pain scores,
fever, and many other morbidities were higher in the ERCP group.
Conclusion
In post-LC bile leak, ERCP is not mandatory for patients who have a patent biliary
tree with normal anatomy in MRCP study. In these patients, ERCP is better to be
avoided as an initial step and should be restricted to the resistant cases. |
