Title: Conservative Management of Post-Operative GI Bile Leaks
Authors: Dr P. Mythili MS. Dr Sangu Karuna Reddy, Dr Yesu Prasad, Dr Vidya Sagar
DOI: https://dx.doi.org/10.18535/jmscr/v7i10.56
Abstract
Background: Postoperative bile leaks is an infrequent but a serious disorder. Majority of the cases of bile leak present follows hepato-biliary surgeries. Some of them are associated with gastro-intestinal (GI) anastomotic leaks. Traditionally surgery has been the gold standard for GI anastomotic leaks. However, conservative management with regular ultrasounds and medications has reduced the morbidity and mortality of patients. Most of the leaks settle with conservative treatment. Endoscopic procedures with percutaneous drainage has been the gold standard for postoperative bile leaks in hepato-biliary surgeries.
Methods and Materials: A Prospective study was conducted from June 2017 to July 2018 on eight patients in the Departmen of General Surgery, King George Hospital ,Andhra Medical College, Visakhapatnam on postoperative bile leaks.
Results: The definitive management of post-operative bile leak was done within a range of 60 days. Conservative management was done in GI anastomotic bile leaks in 06 patients. Endoscopic procedures with percutaneous drainage was done in 02 patients of hepato-biliary surgeries. Conservative management was effective in all the patients with GI anastomotic bile leaks in postoperative patients.
Conclusion: Conservative management is preferred in post- operative GI anastomotic bile leak. Endoscopic management with percutaneous drainage is preferred in simple bile leaks. Conservative management reduces morbidity and mortality in post op bile leak patients.
References
- Pioche M, ponchon T. management of bile leaks J visc. Surg. 2013;150(3):s33-8.
- Chinney GE, Krige JEJ, Bornman PC, Bernon MM, Al-Harethi S, Hofmeyr S, et al. Endoscopic management of postoperative bile leaks after laproscopic cholecystectomy. S Afr J Surg. 2013;51(4):116-21.
- Karvonen J, Gullichen R, laine s, salminen P, gronroosJM. Bile duct injuries during laproscopic cholecystectomy: primary and long term results from a single institution .surgendosc2007;21(7):1069-73.
- Davids PH, Rauws EA, tytgat GN, Huibregtse K. postoperative bile leakage : endoscopic management. Gut. 1992;33(8):1339-41.
- Mortensen J, Kruse A. Endoscopic management of post operative bile leaks. Br J Surg. 1992;79(12):1339-41.
- Collins PG, Gorey TF. Iatrogenic biliary stricture: presentation and management. Br J Surg, 1984;71(12):980-2.
- Way LW, Stewart L, Gantert W, Liu K Lee CM, whang K et al. Causes and prevention of laproscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460-9.
- Rauws EAJ, Gouma DJ. Endoscopic and surgical management of bilr bile duct injuries after laproscopic cholecystectomy. Best Pract Res Clin Gastroenterol. 2004; 18(5):829-46.
- Agarwal N, Sharma BC, Garg S , Kumar R, Sarin SK. Endoscopic management of postoperative bile leaks. hepatobiliary pancreat Dis Int. 2006;5(2):273-7.
- De Reuver PR, Busch OR, Rauws EA, Lameris JS Van Gulik TM, Gouma DJ. long term results of a primary end to end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg. 2007;11(3):296-302.