Assessment of the Relaparotomy Results
Fifty-one LLDs (2.4 %) with a median age 27 years (min-max: 20-51 years) underwent 53 relaparotomy due to various biliary complications. A sum of 107 relaparotomy procedures were performed and 53 of them were related with various biliary complications. Median time from LDH to relaparotomy was 20 days (min-max: 1-97 days). Thirteen of the relaparotomies received HJ (one LLD had twice relaparotomy for a second HJ). Only two LLDs underwent HJ during relaparotomy for acute biliary peritonitis. One of these two LLDs underwent early relaparotomy due to a bilioma which was 10 cm in diameter resulted in peritonitis. An ischemic section consisting right ductal stump of the main bile duct was diagnosed, and a HJ was performed between the ischemic section of the bile duct and a jejunal Roux limb, preserving the continuity of bile flow via common bile duct. Although external-internal PTBD catheter was inserted in another LLD to prevent postoperative bile leaks, bile leaks persisted and acute abdomen findings developed. Therefore, PTBD catheter assisted HJ was performed in the laparotomy performed for acute abdomen findings. Remaining 40 patients that underwent re-laparotomy, the indications were biliary peritonitis, drainage of fluid/bilioma, high output bile leaks in the early postoperative period (≥300 cc pure bile leaks) and duodenal perforation due to ERCP. A biliary drainage catheter extending from the cystic duct stump to the intrahepatic bile ducts was placed in 13 LLDs for bile leaks from cut surface or bile duct stump. Procedure for repair of bile leaks was mentioned above. Following bilioma drainage and a drainage tube placement, surgical procedure was finalized in 26 LLDs. Remaining one LLD underwent relaparotomy due to duodenal perforation following ERCP.