Endoscopic management of cystic duct stump leakage after cholecystectomy.

BACKGROUND/AIMS: Cystic duct stump leakage (CDL) is a rare and serious complication after cholecystectomy. Since laparoscopic cholecystectomy has been gold standard treatment of gallstone disease, this complication is found more frequently. Endoscopic management is now highly recommended and more appropriate than surgical correction, that would be evaluated.

METHODOLOGY: From January 1994 to December 2004, sixteen consecutive cases of patients with CDL after cholecystectomy were managed by endoscopic retrograde cholangiopancreatography (ERCP) in our unit. Endoscopic sphincterotomy (EST), stone extraction, stenting and nasobiliary tube drainage were selected to manage each patient with appropiate indication. Failed cannulation cases were corrected by open choledochojejunostomy. We also reviewed the time from cholecystectomy to presentation, presenting symptoms, treatment procedures and outcome.

RESULTS: A total of 16 patients; 9 women, 7 men average age 57.7 years with CDL after cholecystectomy were studied, 12 had undergone laparoscopic, and 4 had open cholecystectomy. Median time of presenting symptoms after cholecystectomy was 10.3 days (range 3-25 days). Symptoms included abdominal distension 100%, pain 87.5%, jaundice 62.5% and fever 37.5%. Diagnostic and therapeutic ERCP was successful in 14 cases comprising EST 2, EST+stone extraction 2, EST+ stone extraction +stent 2, EST+stone extraction + nasobiliary tube 1 and only plastic stent 7. Failed connulation in 2 cases, underwent open choledochojejunostomy. Median follow up time was 18.2 months (range 1-96 months) in 13 cases with no mortality.

CONCLUSIONS: CDL is a serious complication, more frequently after LC than OC. ERCP with combined endoscopic procedure is the treatment of choice to resolve the bile leakage.