MANAGEMENT OF POST LAPAROSCOPIC CHOLECYSTECTOMY BILE LEAK

Background: Laparoscopic cholecystectomy is the standard management for gallstones, but remains the most common cause of bile leak, mainly due to extra-hepatic duct injury. Though rare, it can lead to serious complications. Aim: To assess the predictors and management of post-laparoscopic cholecystectomy biliary leakage at the Department of Surgery, National Liver Institute, Menoufia University. Patients and methods: This prospective research has been performed on cases admitted with biliary leakage after laparoscopic cholecystectomy at the Hepato-Pancreato-Biliary (HPB) department, National Liver Institute, Menofia University, from June 2020 to June 2023. Results: Bile leak was confirmed in all patients, with common presentations including abdominal pain (67.3%), jaundice (40.8%), and sepsis (26.5%). Imaging revealed various injury levels, and according to the Strasberg classification, Type E1 was the most frequent (26.5%). Operative repair was performed in 55.1% of patients, mostly by Roux-en-Y hepaticojejunostomy. Short-term complications were noted in 29.6% of cases, including wound and chest infections, biliary leaks, and others. Long-term complications occurred in 18.5% due to hepaticojejunostomy strictures. Overall mortality was 4.1%, with deaths related to severe septic conditions. Conclusions: Early detection, accurate imaging, and tailored treatment are essential in treating bile duct injuries following laparoscopic cholecystectomy. Multidisciplinary care is crucial, especially for patients with comorbidities.