Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol

Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Indian Journal of Gastroenterology 03/2005; 24(2):55-8.
Source: PubMed


Conservative surgery (cyst evacuation and partial pericystectomy) for hydatid cysts of the liver is known to be safe but is often associated with bile leak and its sequelae.
Case records of 86 patients undergoing surgery for hydatid cysts of the liver at a tertiary-care center in northern India over a 14-year period were reviewed retrospectively.
Sixteen (18%) patients had jaundice and 36 (42%) had a cyst-biliary communication detected at surgery. Biliary complications developed in 14 (16%) patients. Bile leaks and bilio-cutaneous fistulae were observed in 11 (13%) patients; the fistula output was low (< 300 mL/day) in 8 of these. Three patients had localized intra-abdominal bile collections; all 3 underwent percutaneous drainage of biloma (subsequent laparotomy and lavage was required in one patient due to failure of percutaneous drainage), producing controlled low-output bilio-cutaneous fistulae in all. All low-output fistulae closed spontaneously after a mean duration of 4 weeks. Patients with high-output fistulae underwent endoscopic intervention (stenting/naso-biliary drainage), resulting in the conversion of these fistulae to low-output category and eventual closure after a mean duration of 7.5 weeks.
Postoperative bile leaks lead to significant morbidity after surgical management of hydatid cysts of liver. A majority of them resolve spontaneously. Biliary drainage (endoscopic or surgical) hastens the closure of these bilio-cutaneous fistulae.

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    • "The most commonly accepted definition of a bile leak requires the presence of bile discharge from an abdominal wound and/or drain, with a total bilirubin level of >5 mg/ml or three-times the serum level, intra-abdominal collections of bile confirmed by percutaneous aspiration or cholangiographic evidence of dye leaking from the opacified bile ducts [16]. Surgery for hydatid disease may also lead to internal biliary leaks, with a frequency between 4 % and 28 %, mainly when deeply located cysts and right lobe cysts are excised [17]. "
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    Insights into Imaging 11/2012; 4(1). DOI:10.1007/s13244-012-0200-1
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    • "Number Author N = Bile leaks Presentation Management Comments (1) Agarwal et al. [12] 86 14 (16%) Bile cutaneous fistula 11; biloma 3 Spontaneous closure in 11; ERCP in 3 All leaks in conservative surgery group (2) Puliga et al. [13] 232 27 (11.6%) — — 25.2% leaks in conservative; 2.8% in radical (3) Unalp et al. [14] 183 24 (13.1%) 17 low output; 7 high output 17 spontaneous closure; 7 ERCP All conservative surgery (4) Silva et al. [15] 30 7 (23.3%) "
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    ABSTRACT: Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management.
    HPB Surgery 05/2012; 2012(4):752932. DOI:10.1155/2012/752932
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