After cholecystectomy, the cystic duct is the most common location of bile leak. Typically, the therapy of choice is conservative. The cure rate of bile leaks is more than 90% when adequate percutaneous draining of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting are used. If these interventions fail or are not available, then surgical revision is the next option. Bile leaks can be revised either by re-opening the abdomen or by performing a minor laparoscopy.
In patients who do not improve with conservative management, further diagnostic workup should be performed to exclude other causes of abdominal pain. For example, if an intra-abdominal abscess is found during imaging studies or at operation, then this would require additional treatment beyond simple drainage. In such cases, the surgeon may need to perform an incisional hernia repair after removing all infected tissue.
Bile leaks can also lead to severe complications if not treated properly including infection and liver failure. Therefore, it is important for patients to receive proper postoperative care following gallbladder surgery. Patients should be instructed on how to manage any pain or symptoms that may occur following surgery. They should also be advised to contact their doctor immediately if they experience any signs of infection such as fever, pain around the site of surgery, or redness of the skin.
Surgery is required in only 10% of cases.
Bile leaks can be divided into two categories: post-operative and idiopathic. Post-operative bile leaks occur after surgery for malignancies of the pancreas, liver, or biliary tree. These patients are often older and may have other co-morbid conditions that make them poor surgical candidates. Idiopathic bile leaks have no apparent cause; they may be due to a congenital defect of the biliary system or acquired after trauma to the area. They may also be caused by cysts or tumors in the area surrounding the hepatobiliary system.
The treatment of choice for both post-operative and idiopathic bile leaks is the same: drainage of the biloma using percutaneous techniques followed by closure of any remaining holes in the wall of the bile duct using either plastic or metal stents. This prevents further contamination of the wound site and allows time for granulation tissue to form over the leak before it is closed off. Stent placement can usually be done under local anesthesia with good results.
Bile leaks are a surgeon's worst nightmare and should be corrected as soon as possible. While minor leaks can be treated with simple drainage, major leaks and bile duct damage necessitate endoscopic or percutaneous drainage with or without surgery. Once the source of the bile leak is removed, the bile duct will close itself.
A bile leak is a small amount of blood that comes from between your skin cells and into the area where there is liver tissue (i.e., the abdominal wall). This blood contains proteins that help digest fat in your stomach. Your body is very efficient at removing these proteins through an action called "renal excretion." That is, they are filtered out of the blood by the kidneys and then re-excreted back into the gut via the urine.
The most common cause of bile leaks is alcohol consumption. Other causes include cancerous tumors on the liver, trauma to the abdomen, and blockages in any part of the biliary system (which includes the gallbladder, pancreas, and common bile duct).
Bile leaks can be either internal or external. Internal leaks occur when parts of the liver or of the bile ducts break down under the pressure of severe scarring or tumor growth. These areas of destruction release enzymes that lead to inflammation and ultimately to leakage.
Most surgeons put the drain after cholecystectomy with the hope that it would aid in the detection of postoperative bleeding or bile leakage and the prevention of intra-abdominal infection. However, several studies have shown that drains are not necessary after cholecystectomy.
The American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend placing a drainage tube after any form of gastrointestinal endoscopic procedure to prevent serious complications such as perforation or obstruction. In addition, the society recommends draining abdominal fluid collections after exploratory laparotomy or ultrasonography-guided liver biopsy to reduce the risk of infection. Finally, the society states that there is insufficient evidence to determine whether drainage improves clinical outcomes after acute pancreatitis.
Drains are useful after certain types of abdominal surgery because the intestines and other organs may bleed or leak bile into the abdomen after their blood supply has been cut off. A drain can help physicians see this bleeding or bile leakage before they become problems that require further treatment.
Drain placement is also helpful in reducing the risk of infection. The intestines absorb many bacteria from the digestive system through their lining (mucosa). These bacteria trigger an immune response that helps fight infection.