Outcome of early endoscopic biliary drainage in the management of bile leaks after hepatic resection

Background: Bile leaks are a major cause of morbidity and mortality after liver resection. Endoscopic stent insertion is the treatment of choice, although the optimal timing of stent placement has not been established. This study reviewed the outcome of early endoscopic biliary stent insertion for treatment of bile leaks after hepatic resection. Methods: One hundred fifteen patients underwent hepatic resection in a single unit from July 1995 to December 2000. The type of liver resection, clinical presentation of bile leaks, findings on ERCP, and outcomes after stent placement were recorded. Results: Twenty patients (17%) had bile leaks; 15 had bile in surgical drains but were asymptomatic, and 5 had clinical evidence of a subphrenic collection. In one patient the leak closed spontaneously. The remaining 19 patients underwent ERCP Fifteen had a leak from a peripheral biliary radical and an endoscopic stent was inserted. Two had a hepatic duct stump leak and were treated by nasobiliary drainage followed by stent insertion. In the remaining 2 patients cholangiography did not demonstrate a leak but a plastic stent was inserted. ERCP was performed a median of 6 days (range 5 to 10 days) after surgery. There was no ERCP-related complication. Median hospital stay in the 95 patients without a bile leak was 10 days (range 4-30 days) compared with 15 days (range 10-41 days) for those with bile leaks (NS). Stents were removed endoscopically at 6 weeks with no persistent leaks detected. There were no late biliary complications (median follow-up 26 months, range 12-72 months). Conclusions: Early endoscopic biliary stent insertion is effective in the management of bile leakage after hepatic resection.