Introduction. We studied efficacy of minimally invasive treatment of postcholecystectomy bile leak.
Materials and methods. Results of treatment of 285 patients with bile leakage after cholecystectomy were analyzed. All patients were treated in the Ukrainian National Institute of Surgery from 2005 to 2014; 79 patients were treated in the Institute for the first time, the others had therapy different hospitals before. Two main groups were created. First group with external biliary drainage, the second group without external bile drainage. Ultrasound, CT, MRCP, fistulography, ERCP were used as diagnostic methods. We determined the source and intensity of bile leakage, localization of liquid formations, the state of the bile ducts. After diagnosing percutaneous drainage, endoscopic sphincterotomy with/without endobiliary stenting were performed. If patient’s condition did not improve, relaparoscopy was performed, but at the early stages of study we used laparotomy.
Results. In first group retrograde pancreatocholangiography, papilosphincterotomy and litoextraction were performed in 93.2 % of all cases. Bile leakage stopped in 6 (15.8%) patients of second group. Endoscopic sphincterotomy with/without endobiliary stenting were performed in 17 patients. Percutaneous drainage was performed in 10 patients. Relaparoscopy and laparotomy were performed in 8 and 9 patients correspondently. One patient died.
Conclusions. Endoscopic and percutaneous intervention, relaparoscopy are mini-invasive and effective methods in every kind of postcholecystectomy bile leakage.