Post‐cholecystectomy cystic duct stump leak: a preventable morbidity

Abstract

OBJECTIVE: While major bile duct injury is the most serious complication following laparoscopic cholecystectomy, bile leak from the cystic duct stump remains the commonest morbidity. This is a retrospective assessment of all patients who had a cholecystectomy over a 5‐year period from April 2003 to March 2008. METHODS: Data related to bile leakage were obtained from the Unisoft endoscopic retrograde cholangio‐pancreatography (ERCP) database. RESULTS: Overall 2011 cholecystectomies were performed, of which 488 were done as emergency procedures. Thirteen patients had significant bile leakage, three of which were from accessory ducts, in one the source could not be identified and nine had a cystic duct stump leak (CDSL), which formed the basis of this study. Eight of the nine CDSL patients had successful ERCP and stenting. One had a percutaneous trans‐hepatic cholangiography and stenting. CDSL following emergency laparoscopic cholecystectomy was up to threefold higher than after elective procedures. CONCLUSION: The CDSL of 0.44% was comparable to the reported incidence in the literature. Endoscopic management remains the treatment of choice. Emergency cholecystectomies seem to have a higher incidence of CDSL.

Evaluation of Operative Notes Concerning Laparoscopic Cholecystectomy: Are Standards Being Met?

“…Steps 2 and 5 are already included in the general operative note’s guideline. Adding the description of steps 1, 3, 4, and 6 provides a better basis for postoperative care, as all of these steps may lead to complications [2, 6, 7]. …”

Biliary Leaks and Thoracobiliary Fistula

“…The cystic duct stump, ducts of Luschka, other ducts in the gallbladder fossa, and major extrahepatic bile ducts comprise the potential sites of biliary leakage. The cystic duct stump represents the most common site of leak and reported risk factors include emergency surgery, incomplete or disrupted closure of the cystic duct, width and degree of inflammation of the cystic duct, and presence of common bile duct stones [5,6]. The risk factors for biliary leaks related to major bile duct injury and classification of biliary injury following cholecystectomy have been reported previously and a complete discussion is beyond the scope of this chapter [7].…”

Ex Vivo Evaluation of the ArtVentive EOS Occlusion Device for the Management of Biliary Leaks

“…[1]. Cystic duct leaks are the most common complication following cholecystectomy [2]. Traditionally, intrahepatic biliary leaks required hepatic resection [3], bile duct reconstruction [4] or fistula enterostomy [5], while cystic duct leaks required re-laparotomy and oversewing.…”