Decreasing mortality of bile leaks after elective hepatic surgery.
BACKGROUND: Bile leak is a serious complication following major hepatic surgery. It is associated with significant mortality rates if reoperative management is attempted. We evaluated our experience with aggressive, nonoperative management of postoperative biliary complications. METHODS: All medical records of patients undergoing major liver resection, cryosurgery or radiofrequency ablation from September 1996 through March 1999 were reviewed. RESULTS: Seventy-four patients were identified, and 9 (12%) developed bile leaks. Biliary leaks were investigated with endoscopic retrograde cholangiopancreatography (ERCP) and treated with endoscopic stenting when possible. The bile leak was found to originate from the resected duct stump or ablated surface of the liver in all cases. Patients were treated with ERCP stent placement (5), computed tomography-guided percutaneous drainage (3), and hepaticojejunostomy "chimney" (1). Six of 9 patients had resolution of their bile leak with the mean time of removal of the drain of 4.7 months. There was only 1 death, and that patient died nearly 3 months after surgery from complications not directly related to the bile leak. CONCLUSIONS: Bile leak after liver resection can be managed nonoperatively in most cases with a combination of percutaneous drain placement and biliary stenting. Most bile leaks will close with time, although a drain may be required for many months.