Evidence-based algorithm for management of biliary leaks following laparoscopic cholecystectomy (LC)
In the era of LC, ERCP is the diagnostic and therapeutic modality of choice for post-up bile leaks. The existing algorithm has to be modified when leaks (a) fail to resolve with stenting or sphx or (b) cannot be localized by ERCP. The following algorithm reflects our experience of post-LC bile leaks at a tertiary care center. ERC= Endoscopic Retrograde Occ ERC = Occlusion Cholangiogram Cholangiogram CT = Computed Tomogram Sphx = Biliary Sphineterotomy US = Transabdominal Ultrasound NBD = Nasobiliary Drain PBD = Percutaneous Biliary Drain Seq seg = Sequestered Segment PD = Percutaneous Drain (e.g.J-P) (*1) = leave 2-4 weeks (*2) = consider CT with nasobiliary cholangiogram.