Abdominal Wall Biloma: An Unusual Complication of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) was first described in 1988 by Reddick, Dubois, and Perissat. With improvement in laparoscopic instrumentation and increased expertise of surgeons, LC has rapidly become the procedure of choice for the treatment of symptomatic cholelithiasis. Unfortunately, LC is associated with a higher rate of complication than open cholecystectomy. The incidence of extrahepatic biliary tract injury is reported to be 4% in early series and 0.3% in more recent reports. This is still about three times higher than the 0.125% bile duct injury rate for open cholecystectomy (OC). Cystic duct leak represents 19% of biliary tract injuries. Diagnosis and evaluation of a leak site may be made by HIDA scan of the biliary tree. Some biliary leaks may be managed expectantly. Drainage of the bile collection followed by close observation often serves as definitive therapy. However, some bile leaks require a more aggressive form of intervention for the eventual resolution. The most common form of intervention is endoscopic retrograde cholangiopancreatography (ERCP) with or without biliary endoprosthesis placement. Some patients will require concomitant sphincterotomy. The second most common form of intervention is reoperation (open or laparoscopic) and re-ligation of the cystic duct stump. This approach is more commonly utilized for early or persistent leaks. Between 1989 and the time of this report, we have performed 1024 LC's. In this report, we describe an unusual post-LC complication which was managed nonoperatively.