Bile leaks from the duct of Luschka (subvesical duct): a review

Abstract

Subvesical duct leaks occur after cholecystectomy regardless of gallbladder pathology or urgency of operation. They have been encountered more frequently in the era of laparoscopic cholecystectomy. Intraoperative cholangiography does not detect all such leaks. Staying close to the gallbladder wall during its removal from the fossa is the only known prophylactic measure. ERCP and stent placement are the most common effective diagnostic and therapeutic methods used. Intraoperative and perioperative adjunctive measures, such as fibrin glue instillation and pharmacologic relaxation of the sphincter of Oddi, can potentially be used in lowering the incidence of subvesical bile leaks.

Elective laparoscopic cholecystectomy in the presence of common bile duct stent

“…In the literature significant post-LC bile leaks occur in approximately 0.2-2% of patients [8]. Therefore, it was a surprise to find that 40% of patients who had elective LC with stent in situ developed a postoperative bile leak.…”

“…This compared to nil in the other two groups [OR = 0.02 (0.00-0.42), p = 0.01]. After cholecystectomy bile leaks occur most commonly from injuries to the cystic duct [9], the bile ducts Surg Endosc (2011) 25:429-436 433 of Luschka, or subvesical ducts, which are small ducts that originate from the right hepatic lobe, course along the gallbladder fossa, and usually drain into the extrahepatic bile ducts [8]. All the patients in this study with a bile leak underwent ERCP and restenting.…”

ENBD tube placement prior to laparoscopic cholecystectomy may reduce the rate of complications in cases with predictably complicating biliary anomalies

“…Many authors have pointed out that the majority of bile duct injuries directly result from the surgeon's oversight of bile duct anomalies [3,[13][14][15]. For example, the anomalous hepatic duct might be mistaken for the cystic duct.…”

Bile leaks from the duct of Luschka

“…Rulli and Grasso regarding our paper [1]. Their report of a subvesical duct leak after using the 10-mm harmonic scalpel during laparoscopic cholecystectomy raises a few important points.…”