A ten-year study on non-surgical treatment of postoperative bile leakage

AIM: To summarize systematically our ten-year experiencein non-surgical treatment of postoperative bile leakage, andexplore its methods and indications.METHODS: The clinical data of 57 patients with postoperativebile leakage treated non-surgically from January 1991 toDecember 2000 were reviewed retrospectively.RESULTS: The site of the leakage was mainly the disruptedor damaged fistulous tracts oft tube in 25 patients (43.9 %),the fossae of gallbladder in 14 cases (24.6 %), the cut surfaceof liver in 7 cases(12.3 %), and it was undetectable in theother 2 cases. Besides bile leakage, the wrong ligation of bileducts was found in 3 patients, residual stones of the distal bileduct in 5 patients, benign papillary strictures in 3, and bilomaresulting from bile collections in 2. The diagnoses were madeaccording to the history of surgery, clinical situation, abdominalparacentesis, ultrasonography, ERCP, PTC, MRI/MRCP,gastroscopy and percutaneous fistulography. All 57 patientswere treated non-surgically at the beginning of bile leakage.The non-surgical methods included keeping original drainageunobstructed, percutaneous abdominal paracentesis ordrainage, percutaneous transhepatic cholangial/biliary drainage(PTCD/PTBD),endoscopic management, traditional Chinesemedicine and so on. Of the 57 patients,2 patients died,5 wereconverted to reoperation later, the other 50 were directly curedby non-surgical methods without any complication. The curerate of the non-surgery was 82.5 % (50/57).CONCLUSION: Many nonoperative methods are availableto treat postoperative bile leakage. Non-surgical treatmentmay serve as the first choice for the treatment of bile leakagefor its advantages in higher cure rate, convenience and safetyin practice. It is important to choose the specific non-surgicalmethod according to the volume, site of bile leakage andpatient′s condition.