Advantages of sphincterotomy and nasobiliary tube drainage in the treatment of cystic duct stump leak complicating laparoscopic cholecystectomy.

Abstract

We have used sphincterotomy and nasobiliary tube drainage in preference to other forms of endoscopic therapy to manage three cases of cystic duct stump leak complicating laparoscopic cholecystectomy. The ability to monitor daily nasobiliary tube output and to perform repeat cholangiograms without subjecting the patients to multiple endoscopies permitted precise determination of cystic duct stump leak closure and timely discharge. We observed that an approximate doubling of the 24-h nasobiliary tube output coincided with closure of the cystic duct stump leak at cholangiography. Bile ascites was present in two of the cases and was conveniently removed by CT-guided placement of peritoneal drains. All cystic duct stump leaks sealed after 5 days of nasobiliary tube drainage. The advantages of sphincterotomy and nasobiliary tube drainage include precise determination of cystic duct leak closure, final device removal without follow-up endoscopy, and ongoing decompression of the biliary tree after removal of the nasobiliary tube.