Endoscopic therapy for biliary leaks from aberrant right hepatic ducts severed during cholecystectomy.

Bile leaks after cholecystectomy are relatively frequent. Laparoscopic as opposed to “open” cholecystectomy is thought to carry an increased risk for biliary tract injury.1 Although leaks from the cystic duct stump (CDS) and bile duct are more frequent,2 leaks originating from aberrant bile ducts are also relatively common.3 Communicating leaks are usually managed endoscopically by biliary sphincterotomy with or without nasobiliary drain or stent placement,2,4 or by stent placement alone without sphincterotomy.5 However, noncommunicating leaks, which occur when an aberrant bile duct is severed, are not only challenging to manage endoscopically but also difficult to identify, thereby delaying treatment. 3 Although leak sites have been embolized and sclerosed transhepatically,6 surgery is the predominant therapeutic option for patients with this complication of cholecystectomy.7-9 Surgical therapy has limitations and it would be desirable if leak closure could be achieved by a less invasive endoscopic method. Two patients are described with leaks from a completely severed aberrant right hepatic ductal branch at cholecystectomy that were successfully identified and managed endoscopically.