Original article
Endoscopic therapy for biliary leak after laparoscopic cholecystectomy – diagnostic limitations and choice of therapy option

Introduction: Biliary leak after laparoscopic cholecystectomy (LCH) occurs in 0.7–8% of patients and endoscopic
treatment is the therapy of choice. However, these methods have certain limitations, and choice of therapeutic option is still controversial.
Aim: The aim of the paper is to describe a series of biliary leak cases after LCH, which were treated using endoscopy, and to analyse diagnostic performance and the used therapy method.
Materials and methods: 20 patients, who underwent endoscopic retrograde cholangiography (ERC) within day 0 and day 7 after surgery, were analyzed. Bergman’s type A damage was found in 60%, type C in 20%, type D in 10% and
no biliary leak in the remaining 10%. 90% of patients had a prosthesis placed, and in 89% this was preceded
by endoscopic sphincterotomy (ES) during the first procedure, and in 11% during the second ERC.
Results: In general, endoscopic management permitted fistula closure in 90% of treated patients. Biliary leak was
visualized in 85% during the first ERC, and 75% coexisting biliary duct pathology was diagnosed during the procedure. A follow-up examination increased diagnostic performance up to 90% and revealed the remaining 25% of the
coexisting pathologies, which concerned 60% of patients in total. 10% of 5 Fr prostheses had to be replaced with
larger ones.
Conclusions: Due to the small number of patients, only trends could be delineated. Endoscopic procedures allow fistula closure in 90% of patients with biliary leak. 15% of leaks are not visualized during the first examination. Every fourth case of coexisting pathology is recognized only in the follow-up examination. In most patients ES is required prior to prosthesis placement in order to achieve safe and effective drainage. 22% of 5 Fr prostheses required replacement with larger ones due to inadequate drainage.