English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

We read with interest the paper by Massimiliano et al [1] which described a technique of “pulling-out of abdominal drain,” which was placed close to the fistula site in patients with refractory Bergmann’s type A leak to facilitate closure of fistula. Bile leak occurs in approximately 1% to 4% of patients after laparoscopic cholecystectomy and cystic duct stump is the most common site of leak [2, 3]. Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred therapeutic modality for management of bile duct leaks [4, 5]. Endoscopic stenting with or without sphincterotomy decreases biliary pressure and minimizes flow through the leak. The technique of pulling out the drain tube described by the authors is effective and also a common practice at our center. However, we take two additional measures in patients with persistent leak after adequate endotherapy: 1. Replace the drain tube with a smaller-diameter tube (e. g. 16F nasogastric tube); and 2. Convert gravity-assisted drainage to a colostomy bag drainage to remove the effect of gravity. These measures help close the fistula in almost all patients. Let’s understand the physical principles of fluid dynamics behind these measures: (i) Fluid or air flows from high pressure zone to low pressure zone; and (ii) Compartments that are contiguous with each other have same pressure.

Refractory Bergmann type A bile leak: effect of gravity and tube sizing