Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study

S. Wise Unger; G. L. Glick; M. Landeros; John Cosgrove; Jeffrey Crooms; Dan Deziel; Moshe Dudai; David Easter; David Edelman; Robert Fitzgibbons; Ariel Halevy; Charles Haynie; John Hunter; Demetrius Litwin; Alex Nagy; Douglas Olsen; Edward Philips; Barry Salky; Bruce Schirmer; J. Stephen Scott; Carol Scott-Connor; Irwin Simon; Nathaniel Soper; Lee Swanstrom; William Traverso; Michael Woods

doi:10.1007/s004649900276

Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study

S. Wise Unger, G. L. Glick, M. Landeros, John Cosgrove, Jeffrey Crooms, Dan Deziel, Moshe Dudai, David Easter, David Edelman, Robert Fitzgibbons, Ariel Halevy, Charles Haynie, John Hunter, Demetrius Litwin, Alex Nagy, Douglas Olsen, Edward Philips, Barry Salky, Bruce Schirmer, J. Stephen ScottCarol Scott-Connor, Irwin Simon, Nathaniel Soper, Lee Swanstrom, William Traverso, Michael Woods

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background: Cystic duct leak is a rare complication of laparoscopic surgery. To study the incidence, presentation, and management of cystic duct leak (CDL) after laparoscopic cholecystectomy (LC) a retrospective study of centers doing large numbers of LC was done. Methods: Patient information was obtained by a questionnaire sent to experienced laparoscopic surgeons. This queried demographic information, course of the original operation, presentation, diagnostic studies, and management of CDL after LC. Results: Some 22,165 LCs were performed by 24 surgeons; there were 58 cases of CDL (0.26%); 21% of the surgeons reported no CDLs; 60% of CDLs occurred in the first 25% of each surgeon's experience, but CDLs continue to occur even in their most recent 10% of cases. Preoperative symptoms, prior surgery, and comorbid conditions did not predict CDL. Acute cholecystitis was present at initial surgery in 47%. Symptoms of CDL an average of 3.1 days post-LC were abdominal pain 78%, fever 26%, nausea 35%, vomiting 22%, abdominal distention 26%, and shoulder pain 12%. WBCs and LFTs were elevated in more than two-thirds of the cases. ERCP was most frequently used to diagnose CDL (53%) and was successful in 97%, although sonogram (40%) and HIDA scan (26%) and CT (26%) were also used. Management included ERCP and ductal decompression in 27 patients, percutaneous drainage in 13 patients, open laparotomy in 14, laparoscopy in three, and observation in two. Patients were discharged an average of 7.4 days post discovery of leak. Stents were removed an average of 30 days post ERCP. Ninety-four percent were complete cures. There was one post-treatment abscess. Two deaths due to multisystem failure unrelated to leak occurred. Conclusions: Cystic duct leak is rare and fairly easily diagnosed. It occurs more frequently during the learning curve, but also after much experience. ERCP and ductal decompression play a large role in treatment, but almost all standard methods of treatment yield successful outcomes with low morbidity.

Original language	English (US)
Pages (from-to)	1189-1193
Number of pages	5
Journal	Surgical endoscopy
Volume	10
Issue number	12
DOIs	https://doi.org/10.1007/s004649900276
State	Published - Dec 1996
Externally published	Yes

Keywords

Bile duct injury
Bile leak
Cystic duct leak
Laparoscopic cholecystectomy

ASJC Scopus subject areas

Surgery

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10.1007/s004649900276

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Wise Unger, S., Glick, G. L., Landeros, M., Cosgrove, J., Crooms, J., Deziel, D., Dudai, M., Easter, D., Edelman, D., Fitzgibbons, R., Halevy, A., Haynie, C., Hunter, J., Litwin, D., Nagy, A., Olsen, D., Philips, E., Salky, B., Schirmer, B., ... Woods, M. (1996). Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study. Surgical endoscopy, 10(12), 1189-1193. https://doi.org/10.1007/s004649900276

Wise Unger, S, Glick, GL, Landeros, M, Cosgrove, J, Crooms, J, Deziel, D, Dudai, M, Easter, D, Edelman, D, Fitzgibbons, R, Halevy, A, Haynie, C, Hunter, J, Litwin, D, Nagy, A, Olsen, D, Philips, E, Salky, B, Schirmer, B, Scott, JS, Scott-Connor, C, Simon, I, Soper, N, Swanstrom, L, Traverso, W & Woods, M 1996, 'Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study', Surgical endoscopy, vol. 10, no. 12, pp. 1189-1193. https://doi.org/10.1007/s004649900276

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title = "Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study",

abstract = "Background: Cystic duct leak is a rare complication of laparoscopic surgery. To study the incidence, presentation, and management of cystic duct leak (CDL) after laparoscopic cholecystectomy (LC) a retrospective study of centers doing large numbers of LC was done. Methods: Patient information was obtained by a questionnaire sent to experienced laparoscopic surgeons. This queried demographic information, course of the original operation, presentation, diagnostic studies, and management of CDL after LC. Results: Some 22,165 LCs were performed by 24 surgeons; there were 58 cases of CDL (0.26%); 21% of the surgeons reported no CDLs; 60% of CDLs occurred in the first 25% of each surgeon's experience, but CDLs continue to occur even in their most recent 10% of cases. Preoperative symptoms, prior surgery, and comorbid conditions did not predict CDL. Acute cholecystitis was present at initial surgery in 47%. Symptoms of CDL an average of 3.1 days post-LC were abdominal pain 78%, fever 26%, nausea 35%, vomiting 22%, abdominal distention 26%, and shoulder pain 12%. WBCs and LFTs were elevated in more than two-thirds of the cases. ERCP was most frequently used to diagnose CDL (53%) and was successful in 97%, although sonogram (40%) and HIDA scan (26%) and CT (26%) were also used. Management included ERCP and ductal decompression in 27 patients, percutaneous drainage in 13 patients, open laparotomy in 14, laparoscopy in three, and observation in two. Patients were discharged an average of 7.4 days post discovery of leak. Stents were removed an average of 30 days post ERCP. Ninety-four percent were complete cures. There was one post-treatment abscess. Two deaths due to multisystem failure unrelated to leak occurred. Conclusions: Cystic duct leak is rare and fairly easily diagnosed. It occurs more frequently during the learning curve, but also after much experience. ERCP and ductal decompression play a large role in treatment, but almost all standard methods of treatment yield successful outcomes with low morbidity.",

keywords = "Bile duct injury, Bile leak, Cystic duct leak, Laparoscopic cholecystectomy",

author = "{Wise Unger}, S. and Glick, {G. L.} and M. Landeros and John Cosgrove and Jeffrey Crooms and Dan Deziel and Moshe Dudai and David Easter and David Edelman and Robert Fitzgibbons and Ariel Halevy and Charles Haynie and John Hunter and Demetrius Litwin and Alex Nagy and Douglas Olsen and Edward Philips and Barry Salky and Bruce Schirmer and Scott, {J. Stephen} and Carol Scott-Connor and Irwin Simon and Nathaniel Soper and Lee Swanstrom and William Traverso and Michael Woods",

year = "1996",

month = dec,

doi = "10.1007/s004649900276",

language = "English (US)",

volume = "10",

pages = "1189--1193",

journal = "Surgical endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "12",

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T1 - Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study

AU - Wise Unger, S.

AU - Glick, G. L.

AU - Landeros, M.

AU - Cosgrove, John

AU - Crooms, Jeffrey

AU - Deziel, Dan

AU - Dudai, Moshe

AU - Easter, David

AU - Edelman, David

AU - Fitzgibbons, Robert

AU - Halevy, Ariel

AU - Haynie, Charles

AU - Hunter, John

AU - Litwin, Demetrius

AU - Nagy, Alex

AU - Olsen, Douglas

AU - Philips, Edward

AU - Salky, Barry

AU - Schirmer, Bruce

AU - Scott, J. Stephen

AU - Scott-Connor, Carol

AU - Simon, Irwin

AU - Soper, Nathaniel

AU - Swanstrom, Lee

AU - Traverso, William

AU - Woods, Michael

PY - 1996/12

Y1 - 1996/12

N2 - Background: Cystic duct leak is a rare complication of laparoscopic surgery. To study the incidence, presentation, and management of cystic duct leak (CDL) after laparoscopic cholecystectomy (LC) a retrospective study of centers doing large numbers of LC was done. Methods: Patient information was obtained by a questionnaire sent to experienced laparoscopic surgeons. This queried demographic information, course of the original operation, presentation, diagnostic studies, and management of CDL after LC. Results: Some 22,165 LCs were performed by 24 surgeons; there were 58 cases of CDL (0.26%); 21% of the surgeons reported no CDLs; 60% of CDLs occurred in the first 25% of each surgeon's experience, but CDLs continue to occur even in their most recent 10% of cases. Preoperative symptoms, prior surgery, and comorbid conditions did not predict CDL. Acute cholecystitis was present at initial surgery in 47%. Symptoms of CDL an average of 3.1 days post-LC were abdominal pain 78%, fever 26%, nausea 35%, vomiting 22%, abdominal distention 26%, and shoulder pain 12%. WBCs and LFTs were elevated in more than two-thirds of the cases. ERCP was most frequently used to diagnose CDL (53%) and was successful in 97%, although sonogram (40%) and HIDA scan (26%) and CT (26%) were also used. Management included ERCP and ductal decompression in 27 patients, percutaneous drainage in 13 patients, open laparotomy in 14, laparoscopy in three, and observation in two. Patients were discharged an average of 7.4 days post discovery of leak. Stents were removed an average of 30 days post ERCP. Ninety-four percent were complete cures. There was one post-treatment abscess. Two deaths due to multisystem failure unrelated to leak occurred. Conclusions: Cystic duct leak is rare and fairly easily diagnosed. It occurs more frequently during the learning curve, but also after much experience. ERCP and ductal decompression play a large role in treatment, but almost all standard methods of treatment yield successful outcomes with low morbidity.

AB - Background: Cystic duct leak is a rare complication of laparoscopic surgery. To study the incidence, presentation, and management of cystic duct leak (CDL) after laparoscopic cholecystectomy (LC) a retrospective study of centers doing large numbers of LC was done. Methods: Patient information was obtained by a questionnaire sent to experienced laparoscopic surgeons. This queried demographic information, course of the original operation, presentation, diagnostic studies, and management of CDL after LC. Results: Some 22,165 LCs were performed by 24 surgeons; there were 58 cases of CDL (0.26%); 21% of the surgeons reported no CDLs; 60% of CDLs occurred in the first 25% of each surgeon's experience, but CDLs continue to occur even in their most recent 10% of cases. Preoperative symptoms, prior surgery, and comorbid conditions did not predict CDL. Acute cholecystitis was present at initial surgery in 47%. Symptoms of CDL an average of 3.1 days post-LC were abdominal pain 78%, fever 26%, nausea 35%, vomiting 22%, abdominal distention 26%, and shoulder pain 12%. WBCs and LFTs were elevated in more than two-thirds of the cases. ERCP was most frequently used to diagnose CDL (53%) and was successful in 97%, although sonogram (40%) and HIDA scan (26%) and CT (26%) were also used. Management included ERCP and ductal decompression in 27 patients, percutaneous drainage in 13 patients, open laparotomy in 14, laparoscopy in three, and observation in two. Patients were discharged an average of 7.4 days post discovery of leak. Stents were removed an average of 30 days post ERCP. Ninety-four percent were complete cures. There was one post-treatment abscess. Two deaths due to multisystem failure unrelated to leak occurred. Conclusions: Cystic duct leak is rare and fairly easily diagnosed. It occurs more frequently during the learning curve, but also after much experience. ERCP and ductal decompression play a large role in treatment, but almost all standard methods of treatment yield successful outcomes with low morbidity.

KW - Bile duct injury

KW - Bile leak

KW - Cystic duct leak

KW - Laparoscopic cholecystectomy

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Cystic duct leak after laparoscopic cholecystectomy a multi-institutional study

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Keywords

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