Bile leak in open cholecystectomy: related to gangrenous cholecystitis?

BACKGROUND

Open cholecystectomy is still required for treatment of gallbladder disease when inflammation has changed the usual anatomic landmarks and make laparoscopic cholecystectomy unsafe or technically impossible.

METHODS

In this study, we reviewed all the records of patients who underwent open or laparoscopic-converted-to-open cholecystectomy between January 2000 and August 2006.

RESULTS

A total of 3367 patients underwent cholecystectomies. Three hundred five patients underwent laparoscopic-converted-to-open, and 123 patients underwent open cholecystectomy. The incidence of bile leaks in the open cholecystectomy group was 2.6% (11/428). Twenty-four percent had gangrenous cholecystitis (102/428). Eight (8/11) of the bile leaks were associated with gangrene. All bile leaks presented within the first five days after surgery with an average of 2.9 days. All patients had bilious output through aJP drain. All leaks resolved over 10 days. Three resolved spontaneously, andeightresolved after ERCP stent.

CONCLUSIONS

The incidence of bile leaks in the open cholecystectomy group was high (2.6%) in our study, compared to other series published. When gangrenous cholecystitis was present, the incidence of bile leaks was 24%. The placement of a JP drain was essential for the identification of the bile leak.