%0 Journal Article
%T Bile Duct Leaks from the Intrahepatic Biliary Tree: A Review of Its Etiology, Incidence, and Management
%A Sorabh Kapoor
%A Samiran Nundy
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/752932
%X Bile leaks from the intrahepatic biliary tree are an important cause of morbidity following hepatic surgery and trauma. Despite reduction in mortality for hepatic surgery in the last 2 decades, bile leaks rates have not changed significantly. In addition to posted operative bile leaks, leaks may occur following drainage of liver abscess and tumor ablation. Most bile leaks from the intrahepatic biliary tree are transient and managed conservatively by drainage alone or endoscopic biliary decompression. Selected cases may require reoperation and enteric drainage or liver resection for management. 1. Introduction Bile leaks mainly result from injury to the extrahepatic bile duct during cholecystectomy [1¨C3]. A bile leak from the intrahepatic biliary tree is less frequent and generally follows liver surgery and after blunt or penetrating abdominal trauma [4¨C6]. Less commonly, bile leaks from the liver may result following drainage of a liver abscess or nonsurgical ablation of liver lesions. The majority of leaks are transient and resolve spontaneously or after nonsurgical interventions like endoscopic retrograde cholangiography and pancreatography (ERCP) with sphincterotomy and/or stenting [6¨C8]. A few will need operative correction. However, these intrahepatic bile duct leaks result in significant patient morbidity leading to a prolongation of hospital stay and increase in healthcare costs. Bile leaks following liver resection also increase mortality rates [7, 9]. In this paper we will discuss how bile leaks are defined paper classified, what their causes are, and how they should be managed. 2. Definition The most common accepted definition of a bile leak requires the presence of the following:(1)bile discharge from an abdominal wound and/or drain, with a total bilirubin level of >5£¿mg/mL or three times the serum level,(2)intra-abdominal collections of bile confirmed by percutaneous aspiration,(3)cholangiographic evidence of dye leaking from the opacified bile ducts [10]. 3. Classification Nagano et al. have classified postoperative bile leaks into four types [10]: Type A: minor leaks from small bile radicles on the surface of the liver which are usually self-limiting, Type B: leaks from inadequate closure of the major bile duct branches on the liver¡¯s surface, Type C: injury to the main duct commonly near the hilum, Type D: leakage due to a transected duct disconnected from the main duct. Type A leaks usually close spontaneously with external drainage although sometimes ERCP and sphincterotomy may be required. Types B and C can be managed by ERCP and
%U http://www.hindawi.com/journals/hpb/2012/752932/