Introduction:

Postcholecystectomy biliary leak is rare. Management is mainly endoscopic, but in the literature, there is no consensus on the first-line technique between sphincterotomy, biliary stent, or combination.

Materials and methods:

A case series study was conducted that included all ERCP performed at the San Ignacio University Hospital in Bogotá, Colombia, between January 2010 and March 2021 due to biliary leak after cholecystectomy. Demographic characteristics, clinical manifestations, resolution, adverse events, and hospital length stay were recorded according to the endoscopic technique.

Results:

24 patients with postcholecystectomy biliary leak managed with ERCP were included. The median age was 59 years (interquartile range [IQR]: 53.5-67). In 75% the surgery was laparoscopic. The most frequent clinical manifestation was increased biliary drainage > 150 mL/24 hours (50%), followed by abdominal pain (39%). The main fistula’s location was the cystic duct in 40%. Management with sphincterotomy was 25%, with a biliary stent, 8.4%, and combined, 66%; leak resolution occurred in 100%, 50%, and 87%, respectively, with a shorter hospital length stay in the combined management of 3.5 days compared to four days in sphincterotomy. Only one adverse bleeding event occurred in the sphincterotomy group.

Conclusion:

Sphincterotomy and combined therapy are options with reasonable resolution rates and low hospital length stay for managing postcholecystectomy biliary leak. Prospective, randomized, and multicenter trials will be required to define the best technique.

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