Biliary Leakage Following Cholecystectomy: A Prospective Population Study
Author(s): Adel Khdair Abbas*
Background: Biliary leakage is the most common and serious complication following cholecystectomy. Because bile duct injury can lead to lifelong disability or even death, iatrogenic bile duct injury therefore should promptly be identified and repaired or the patient should be referred to the specialist who has experience in hepatobiliary surgery. Early diagnosis and treatment is the cornerstone for pleasant outcome. Unrecognized or late diagnosis of bile duct injury can lead to serious consequences such as hepatic failure or death. The objectives of this study were to determine the incidence of biliary leakage following cholecystectomy and to evaluate its outcome following this procedure. Objectives: To determine the incidence of biliary leakage following cholecystectomy and to evaluate its outcome following this procedure. Patient and Methods: A prospective study was conducted among 968 patients in Al – Kadhimain medical city from January 2019 to February 2020. The data were obtained from the patients getting admitted with biliary leakage after cholecystectomy or developed biliary leakage after cholecystectomy at the surgical department in our hospital. The patients were assessed by thorough history, clinical examination and postoperative investigations including abdominal ultrasound, CT abdomen and MRCP to determine the site of bile leakage and the modalities of management that can be used and those patients were followed adequately. Results: A total of 968 cholecystectomies were carried out in this study, out of which 311 were open cholecystectomies and the rest 657 were laparoscopic cholecystectomies. The overall incidence of biliary leak following cholecystectomy was 1.75%. The incidence of major bile duct injury was 0.61% while the incidence of leakage from gallbladder bed, duct of Luschka or minor bile duct injury was 1.13%. 70.58% of bile leak resolve spontaneously with conservative treatment and controlled external fistula but interventions in the form of primary suturing of bile duct and hepaticojejunostomy were done in 29.41% of patients. Two patients (11.76%) died due to delayed presentation. Conclusion: Major bile duct injury following cholecystectomy can be devastating to the patient and needs prompt diagnosis and timely surgical intervention but leakage from gallbladder bed, duct of Luschka or accessory bile duct needs only conservative treatment and careful observation and mostly leads to disappearance of leak without any residual effect.