A Study of Post Choleycystectomy Biliary Leakage and Its Management

INTRODUCTION: Laparoscopic cholecystectomy is now considered the gold standard for the treatment of symptomatic gallstone disease. The advantages of laparoscopic cholecystectomy compared to open surgery is well documented. Some patients complain of symptoms even after complete removal of gallbladder with calculi which lasts even years after the procedure.Persistent postcholecystectomy symptoms' was more accurate description. AIMS AND OBJECTIVES: The aim of this study is to know the outcome of post cholecystectomy biliary leaks and its management. STUDY CENTRE: Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai. DURATION OF STUDY: September 2017 to September 2019. STUDY DESIGN Observational study (Prospective and Retrospective). SAMPLE SIZE: 100. INCLUSION CRITERIA: All cases admitted to surgical wards with biliary leakage after cholecystectomy above 12 years of age. EXCLUSION CRITERIA: Patient undergoing cholecystectomy as a part of some primary operation like Whipple’s operation, biliary-enteric anastomosis are excluded from this study. MATERIALS & METHODS: Pre-operative workup with ultrasound abdomen, LFT and other biochemical investigations were done and diagnosis was established. The outcome of surgery and its most common post-operative complication - biliary leak was studied with following parameters: Post-operative diagnosis, Surgery - Lap or Open, Incision, Method of approach – Fundus or Classical method, CBD exploration, Intra-operative findings, Drains used, Post-operative symptoms, Amount of collections, Removal of drains, USG – Sub hepatic collections, ERCP etc. RESULTS: Among 100 persons,10% were under 30 years ,45% were under 40 years, study vomiting ,early satiety, abdominal pain were analysed in this group study. Early satiety and vomiting were most common symptoms. gallstones was the most commonly indication for lap choleycystectomy. choleycystitis was most found to be 29% and gall stones 61%. 55% under 50 years. Thus most of the patients in my study were between 30 to 50 years of age. female patients were 66% and male patients were 34%.female are pre4dominant in this group. gallstones was the most commonly indication for lap choleycystectomy. choleycystitis was most found to be 29% and gall stones 61%. Total patients were 100 patients included in this study out of 100, 80 underwent lap cholycystectomy and 5were underwent open choleycystectomy Out of 100 patients post choleycystectomy biliary leakage was observed in 25% of patients. bile duct injury was observed only 5% of patients out of 100% patients.gallstones was the most commonly indication for lap choleycystectomy.choleycystitis was most found to be 29% and gall stones 61%. CONCLUSION: Postoperative bile leakage will be managed conservatively if the amount of bile leak is less than 250ml/24 hrs although it might take weeks to settle. In our experience, a structured stepwise approach to the management of uncommon complications such as bile leaks is advantageous. Alternatively, they can be transferred to centres where minimally invasive expertise is routinely available. Most of the biliary leakage can be managed conservatively. Female patients are more prone for gall stones particularly am0ong age group 40 to 50 years of age. Laproscopic choleycystectomy was one of the gold standard procedure foe symptomatic gall stones