Endoscopic nasobiliary drainage for treating bile leak after laparoscopic cholecystectomy.

Objective: Bile leaks are common complications of laparoscopic cholecystectomy. We evaluated the diagnosis and endoscopic treatment of bile leaks.

Methods: A total of 436 patients underwent laparoscopic cholecystectomy with infrahepatic drainage. We performed immediate endoscopic retrograde cholangiopancreatography (ERCP) on all patients with bile discharge from an infrahepatic drain, and treated bile leaks which were not due to a major ductal injury by endoscopic nasobiliary drainage (ENBD) without endoscopic sphincterotomy (ES).

Results: Ten patients developed bile leaks which were recognized within 18 hours of operation. ERCP, on post-operative day 1 or 2, showed a bile leak from the cystic duct (9 patients) or the liver bed (1 patient). All patients underwent ENBD. Only 1 patient, who had a retained stone, had ES. In all patients, the bile leak resolved promptly and both the infrahepatic and nasobiliary drains were removed within 6 days of cholecystectomy. All patients were asymptomatic at a mean follow-up of 30 months.

Conclusions: Routine placement of an infrahepatic drain is recommended for the early detection of bile leaks. Bile leaks can be successfully treated by prompt ENBD without ES.