The role of ERCP in laparoscopic cholecystectomy-related cystic duct stump leaks

Abstract

Background: Laparoscopic cholecystectomy has resulted in an increase in the incidence of cystic duct stump leaks. To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) a review of 14 cystic duct stump leaks following laparoscopic cholecystectomy was carried out.

Methods: A retrospective chart review of fourteen patients was carried out. There were 11 females and 3 males. Laparoscopic cholecystectomy was carried out without any difficulty. Three patients became very ill soon after surgery while 11 patients were minimally ill. All were still hospitalized after the cholecystectomy.

Results: Urgent ERCP on the 3 very ill patients demonstrated a cystic duct bile leak. In the 11 minimally ill patients, ultrasonography demonstrated intraabdominal fluid collections and initial treatment was percutaneous drainage. Only 2 of the 11 patients improved. The remaining nine patients developed a septic course. ERCP was carried out and demonstrated cystic duct bile leak in all 9 patients. Endoscopic papillotomy alone or endoscopic papillotomy plus stenting resolved the clinical picture.

Conclusions: Patients who are ill post laparoscopic cholecystectomy should have urgent ERCP. Cystic duct bile leaks should be managed by endoscopic papillotomy and in select cases, stenting.