Biliary leakage after urgent cholecystectomy: Optimization of endoscopic treatment

Table 1 Clinical characteristics of 30 consecutive patients with post-cholecystectomy biliary leakage included in the study

Parameter	n (%)
Age (yr) (median)	62
Male/female	14 (46.7)/16 (53.3)
Cholecystectomy details
Open	9 (30.0)
Laparoscopic	13 (43.3)
Laparoscopic to open conversion	8 (26.7)
Abdominal drain:
Bile leak ≤ 400 mL/d	24 (80.0)
Bile leak > 400 mL/d	6 (20.0)
Abdominal pain	20 (66.7)
Jaundice	8 (26.7)
Fever	14 (46.7)
Abdominal collection	8 (26.7)
Abdominal distension	6 (20.0)
Ascites	1 (3.3)
Comorbidity
ASA 1-2	24 (80.0)
ASA 3-4	6 (20.0)

ASA: American Society of Anesthesiology.

Table 2 Endoscopic retrograde cholangiography findings in patients with post-cholecystectomy biliary leakage included in the study

1st ERC findings	n (%)
Number of patients	30
Bile leak characteristics
Leak from the cystic duct stump	13 (43.3
Leak from the right hepatic duct or intrahepatic duct	12 (40.0)
Leak from the common bile duct	3 (10.0)
Leak from cholecystohepatic duct of Luschka	1 (3.3)
Could not be located	1 (3.3)
CBD stone(s)	11 (36.7)
Endoscopic management
Biliary stent	13 (43.3)
EBS + stone extraction + biliary stent	11 (36.7)
EBS + biliary stent	6 (20.0)
Adverse effect
Pancreatitis	2 (6.7)
Bleeding	1 (3.3)
1st ERC leakage resolution success rate	23/30 (76.7)
Repeated ERC findings
Number of patients	7
Bile leak characteristics
Leak from the right hepatic duct or intrahepatic duct	6 (85.7)
Could not be located	1 (14.3)
CBD stone(s)	2 (28.6)
Endoscopic management
Biliary stent	5 (71.4)
EBS + extraction + biliary stent	2 (28.6)
Adverse effect	0
ERC leakage resolution success rate	27/30 (90)
Referred to surgery	3 (10)

ERC: Endoscopic retrograde cholangiography; EBS: Endoscopic biliary sphincterotomy; CBD: Common bile duct.

Table 3 Clinical characteristics of endoscopic retrograde cholangiography successfully treated patients with post-cholecystectomy biliary leakage in the long-term follow-up

Parameter	n (%)
Number of patients	27
Abdominal pain	0
Abdominal distension	0
Elevated bilirubin¹	0
Elevated ALT²	13 (48.2)
Dilated common bile duct (> 6 mm)³	0
Death	4 (14.8)

¹Bilirubin > 20 mmol/L; ²ALT > two times above normal; ³Measured by transabdominal or endoscopic ultrasound. ALT: Alanine transaminase.