Aceves-Quintero CA, Padilla-Pérez FJ, Martínez-Ceballos E, Kuri-Osorio JA

Language: Spanish
References: 9
Page: 89-93
PDF size: 192.73 Kb.

ABSTRACT

Introduction: laparoscopic cholecystectomy is the gold standard for gallstone disease, however, it is not free of complications, such as hemorrhage, seroma, biloma, biliary leakage, surgical wound infection and bile duct injury, being the presence of aberrant ducts one of the main risk factors. The anatomical variations of the biliary tract are due to alterations in the embryological development, it is important that the surgeon knows how to recognize them, since during cholecystectomy there is a risk of ligation, section, biliary leak or stenosis of an accessory or aberrant duct. Biliary leaks have increased since the standardization of laparoscopic cholecystectomy, with a frequency of approximately 0.3-0.5%. Endoscopic retrograde cholangiopancreatography (ERCP) is the ideal study, since it confirms the diagnosis by identifying the site of biliary leakage and during the same procedure sphincterotomy and stent placement can be performed, allowing closure of the defect, with a success rate of more than 90%. Clinical cases: we present two cases of biliary leakage after laparoscopic cholecystectomy secondary to the presence of anatomical variations of the extrahepatic biliary tract, both manifested by abdominal pain requiring hospitalization. In the first case the biliary leak was evidenced during ERCP and was resolved with the placement of a stent. The other case, having a negative ERCP and persistence of abdominal pain, underwent diagnostic laparoscopy, finding a biliary leak from an accessory duct, for which a new transoperative ERCP was performed for stent placement. Conclusion: these two cases are very interesting because despite being the same type of biliary leak, they presented differently, one at 72 hours postoperatively and the other at eight days. Likewise, one of them was resolved by ERCP and the other had a negative ERCP before the definitive diagnosis could be made. Therefore, a high index of suspicion of biliary leakage through an accessory or aberrant duct should be taken into account when faced with abdominal pain after laparoscopic cholecystectomy.

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