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Management of patients who return to the hospital with a bile leak after laparoscopic cholecystectomy.

Authors
Kim, JH; Kim, WH; Yoo, BM; Kim, MW
Citation
Journal of laparoendoscopic & advanced surgical techniques. Part A, 20(4):317-322, 2010
Journal Title
Journal of laparoendoscopic & advanced surgical techniques. Part A
ISSN
1092-64291557-9034
Abstract
INTRODUCTION: Bile leaks after laparoscopic cholecystectomy (LC) can be difficult to diagnose early. The aim of this study was to investigate the clinical features of minor bile leaks and to discuss how to manage patients who revisit the hospital with minor bile leaks after LC.



PATIENTS AND METHODS: From January 2001 to September 2007, 2219 LCs were performed at the Ajou University Medical Center. Twenty-four patients (1.0%) who presented with a bile leak or bile duct injury after a cholecystectomy were identified. The patients with minor bile duct injury were divided into two groups, depending on whether they revisited the hospital (group 2) or not (group 1) after LC.



RESULTS: Seventeen of 24 patients had minor bile leaks. The characteristics of patients in group 2 were long hospital stay, short operation time, and low frequency of indwelling surgical drains. Ten of 17 patients (58.8%) revisited the hospital at a mean of 7.0 +/- 2.7 days after the LC. However, 3 of 10 patients (30%) were discharged from the ER with atypical abdominal pain and returned to the hospital again within 5 days due to recurrent abdominal pain. There was a significant correlation between hospital stay and time to endoscopic retrograde cholangiopancreatography (ERCP) (P = 0.008) and between hospital stay and PCD (P = 0.028).



CONCLUSIONS: Most minor bile leaks were managed by ERCP and/or percutaneous drainage. However, early diagnosis was difficult when patients revisited the hospital within 7 days after the LC. Therefore, early ERCP should be considered in these patients to diagnose the bile leak early and limit needed hospital stay.
MeSH terms
AdultBile*Bile Duct Diseases/diagnosis*Bile Duct Diseases/etiologyBile Duct Diseases/therapy*Cholangiopancreatography, Endoscopic RetrogradeCholecystectomy, Laparoscopic/adverse effects*Cohort StudiesDrainageFemaleHumansLength of StayMaleMiddle AgedPatient Readmission*ReoperationRetrospective StudiesRisk FactorsYoung Adult
DOI
10.1089/lap.2009.0241
PMID
20465428
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
AJOU Authors
김, 지훈김, 욱환김, 진홍유, 병무김, 명욱
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