The use of radionuclide imaging in the evaluation of suspected biliary damage during laparoscopic cholecystectomy

Gelman, Russell; Alexander, Michael; Zucker, Karl A.; Bailey, Robert W.

doi:10.1007/bf01887346

Cited by 18 publications

(3 citation statements)

References 11 publications

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“…Our finding of a bile leakage rate of 2% without bile duct injury is similar to other reports of rates of 1-2.4% [4,6,7,11,14,18,24,28,29] and is somewhat higher than rates observed after "open" cholecystectomy [25,27,32,36]. Reasons for the increased incidence of bile leakage after laparoscopic cholecystectomy are speculative.…”

Section: Discussionsupporting

confidence: 76%

“…Although advocated as a method to verify bile leakage [4,9,11,12,31,33], radionuclide scans of the biliary tract may not add significantly to the information which can be obtained from ultrasound and ERCP.…”

Section: Discussionmentioning

confidence: 99%

“…Although it may be a consequence of injury to the common bile duct, it may also occur as a result of leakage from an incompletely secured cystic duct or from small ducts which empty directly into the gallbladder from the liver. There is evidence to suggest that bile leakage is more common after laparoscopic cholecystectomy than after the "open" procedure [3,6,7,11,18,24,28]. Bile leakage usually leads to an extension of hospital stay and may cause serious sepsis and a need for laparotomy [31,33].…”

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confidence: 99%

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Bile leakage following laparoscopic cholecystectomy

et al. 1995

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Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstones, but there has been concern that bile leakage with LC is more frequent than after open cholecystectomy (OC). We have analyzed our experience of this complication with regard to both its incidence and management. From a consecutive series of 500 LC, in which both operative cholangiography and drainage of the gallbladder bed were routine, bile leakage was identified in ten patients (2%). There was no bile duct injury. Nine of the ten patients presented with bile in the drain within 24 h of operation and one patient presented 1 week after operation with a subphrenic collection. Of the ten patients, five settled spontaneously. Of the five remaining patients, two needed laparotomy--one for a subphrenic collection not responding to percutaneous drainage and one for biliary peritonitis. One patient was treated by relaparoscopy and suture of a duct of Luschka and one patient had successful percutaneous drainage of an infected collection; the fifth patient who presented with a late subphrenic collection of bile was shown at endoscopic retrograde cholangiopancreatography (ERCP) to have a cystic duct stump leak and was treated with an endoscopic stent. Bile leakage is seen more frequently after LC than OC for reasons that are currently unclear. We believe that the use of routine gallbladder bed drainage is justified for this reason alone. The majority of bile leaks settle either spontaneously or with minimally invasive intervention.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Bile leakage following laparoscopic cholecystectomy

et al. 1995

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Biliary Tract Disease

Périssat¹,

Pitcher²,

Martin³

et al. 1995

Principles of Laparoscopic Surgery

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Bile leakage after biliary tract surgery

1993

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The incidence of bile leaks has increased with laparoscopic cholecystectomy as compared with open cholecystectomy. Minor bile leaks are not infrequent but are clinically insignificant; of the major bile leaks the most common sequela is the biloma, the most serious, bile peritonitis. Early symptoms may be very subtle; all untoward symptoms should be investigated with a HIDA scan to rule out bile leakage. Positive HIDA scans should be followed with endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiography (PTC). Management of the leakage depends on identification of its source. Prompt identification of ductal injuries permits earlier effective treatment and consequently less morbidity and/or mortality.

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The use of radionuclide imaging in the evaluation of suspected biliary damage during laparoscopic cholecystectomy

Cited by 18 publications

References 11 publications

Bile leakage following laparoscopic cholecystectomy

Bile leakage following laparoscopic cholecystectomy

Biliary Tract Disease

Bile leakage after biliary tract surgery

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