In healthy living liver donors with a persistent postoperative bile leak, what leak- and patient- specific thresholds (e.g., drain output trend, biloma size, systemic inflammatory signs, duct anatomy) push you to early ERCP rather than continued percutaneous drainage and observation?

Typically, a bile leak would be noted because there are some objective findings which prompt an abdominal imaging study, i.e., fever, pain, rising liver chemistry tests, bilious output in Jackson-Pratt drains. A collection suspicious for a bile leak should be drained in order to avoid infection. Cut surface leaks may slowly heal with time, but larger leaks will need drainage and also require an ERCP to decompress the biliary system, even in the absence of a discrete bile duct leak. Discrete bile duct leaks most often will require concurrent ERCP with stent placement in order to allow healing, whereas leaks from Roux limbs may require surgical revision. Clinicians should be aware that strictures may ultimately arise at the sites of previous ...