A postoperative bile leak is a potential complication of cholecystectomy procedures, where the gallbladder is removed. This complication occurs in less than two percent of laparoscopic cholecystectomy cases, and is usually identified after the surgery, when the patient is in recovery. Treatment involves draining the leak and addressing the cause. It can often be accomplished without taking the patient back into surgery, although the patient will need to be placed under sedation for comfort.
Postoperative bile leaks can have a number of causes. One of the most common is a retained bile stone. The stone causes pressure to build up, and can lead to ruptures at the surgical site, allowing bile to leak out. Another potential cause is an injury to the major bile duct. These injuries are often not noticed at the time they occur unless they are significant. In both cases, the patient develops symptoms like nausea, decreased appetite, and abdominal pain after surgery.
A procedure known as endoscopic retrograde cholangiopancreatography can be used to inject tracer dyes to follow the movement of bile visually on a medical imaging study. This procedure will show the leak and provide information about the precise location and size. Repair procedures may be possible through the stents inserted during this procedure, allowing a doctor to address the postoperative bile leak quickly and with minimal stress for the patient, before complications like infection develop as a result of the leak.
Developing a postoperative bile leak is not a sign that a surgeon was incompetent or careless. This complication is rare and has been documented in a wide variety of cases, including cases performed by highly experienced and very attentive situations. Care is taken during surgery to avoid any common causes of bile leaks and patients are monitored after surgery to catch leaks early, in the event they develop, as they are a known risk of procedures involving the gallbladder and liver.
Patients who have had cholecystectomy surgeries and notice symptoms like abdominal pain and nausea should report the symptoms as quickly as possible to a nurse or doctor if they are in the hospital. If the patient has been sent home, the surgeon should be called to discuss the symptoms. If there are concerns that the symptoms are indicative of a bile leak, the patient will be asked to undergo some tests to confirm the leak and then will be provided with information about available treatment options.