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Review Describes Bile Leak Management after Minimally Invasive Subtotal Cholecystectomy

May 13, 2025

Deng SX, Greene B, Habbel C, Bubis L, Tsang ME, Jayaraman S. Management of Bile Leak Post Minimally Invasive Subtotal Cholecystectomy: A Review. Ann Surg. 2025; in press.

Deng and coauthors provided a clearly written, comprehensive review of the management of bile leak following minimally invasive subtotal cholecystectomy.

They included a suggested protocol for management of this complication that is employed at their institution. Data cited in the article confirmed that most bile leaks occur after fenestrating subtotal cholecystectomy. Their institutional protocol recommended placement of a drain at the time of the index operation.

Although most bile leaks resolve spontaneously, persistent leaks should be characterized using sinogram (injected via the drain) imaging. ERCP and stenting are reserved for high-grade or persistent leaks.

Retained stones in the gallbladder may contribute to bile leakage and recurrent cholecystitis. This condition is more common following reconstituting subtotal cholecystectomy and is best managed by completion cholecystectomy, but this procedure is technically challenging and should, ideally, be performed by expert hepatobiliary surgeons. Gallbladder preserving cholecystolithotomy is a useful alternative.

Surgeons are encouraged to review the entire article content.

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