On 5th postoperative day after laparoscopic cholecystectomy, a 50 year old lady presented with right upper quadrant pain with fever and 12 cm subhepatic collection on CT and ERCP shows cystic duct leak. The best management is
Goals of therapy in Iatrogenic bile duct injury Control of infection limiting inflammation Parenteral antibiotics Percutaneous drainage of peripoal fluid collection Clear and thorough delineation of entire biliary anatomy MRCP/PTC ERCP (especially if cystic duct stump leak suspected) Re-establishment of biliary enteric continuity Tension free, mucosa - to-mucosa anastomosis Longterm transanastomotic stents if involving bifurcation of higher Roux-en-Y hepaticojejunostomy Ref: Sabiston 20th edition Pgno :1503
Immediate laparotomy
Percutaneous drainage of fluid
Laparotomy and surgical exploration of bile duct and T-tube inseion
Laparoscopic cystic duct ligation and percutaneous drainage
G.I.T