Management of Postoperative Bile Leak: Tertiary Centers Experience

Mohammed Omar, Alaa Redwan. Sohag university

Background: Bile duct leak is an infrequent but serious disorder. The great majority occurs after hepatobiliary surgery. Early recognition and adequate multidisciplinary approach is the cornerstone for the optimal final outcomes. Traditionally, surgery has been the gold standard for the management of bile leak, but it is associated with significant morbidity and mortality. Biliary endoscopic procedures have become the treatment of choice, as simple, noninvasive procedure, with low morbidity and mortality, short hospital stay, and coast effective, with demonstrated results comparable to those achieved with surgery.

Purpose: A prospective and retrospective work to evaluate management of postoperative bile leak.

Patients and Methods: In the period from Jan. 2005 to Dec. 2014, a random sample of 311 patients (153 females and 158 males) with postoperative bile leak from general surgery departments, and gastro-intestinal endoscopy units, Sohag and Assiut University hospitals were studied and evaluated.

Results: The definitive management of bile leak was done within 0-143 days (median 8 days). Patients were managed accordingly using, endoscopy in 232 patients (plus percutaneous techniques in 8 patients) and surgery in 79 patients. Endoscopic treatment proved very effective in 94.2% of the patients with simple bile leak and 44.3% of the patients with complex bile leak.

Conclusion: Endoscopic treatment substituted surgery in all simple bile leak cases as a competitive treatment. Surgical treatment was the definitive treatment of complex bile leak; however endoscopy was a mandatory complementary tool in initial management.

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