ABSTRACT Complications produced by the sectioning of a nonvisu- alized duct of Luschka are uncommon during laparo- scopic cholecystectomy. From 1999 through 2003, we performed 1351 laparoscopic cholecystectomies in our department and observed 2 cases (0.15%) of bile leakage due to duct of Luschka injury. Injury during laparoscopic cholecystectomy is usually produced by an excessively deep plane of dissection and by the anatomical localiza- tion of this accessory duct. Clinical symptoms are scarce after duct of Luschka injury. Numerous diagnostic meth- ods have been used to detect these injuries. Nevertheless, careful clinical examination is still of the utmost impor- tance. Noninvasive treatments are usually effective. In patients who present with acute abdomen, as in our cases, or who are not cured by noninvasive treatments, exploratory lap- arotomy is the best approach. The surgical treatment con- sists of a lavage of the abdominal cavity, closure of the duct of Luschka, and intraoperative cholangiography to confirm that the biliary tree is intact. Key Words: Luchska, Laparoscopy, Cholecystectomy, Re- view. Liver Transplantation and Hepatobiliary Unit, Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain (all authors). Address reprint requests to: J. M. Ramia, PhD, C/Buensuceso 6, 4D, 18002 Granada, Spain. Telephone: 0034958536859, E-mail: jose_ramia@hotmail.com © 2005 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by the Society of Laparoendoscopic Surgeons, Inc. 216 JSLS (2005)9:216 –217 CASE REPORT Postlaparoscopic Cholecystectomy Bile Leak Secondary to an Accessory Duct of Luschka J. M. Ramia, PhD, K. Muffak, MD, A. Mansilla, PhD, J. Villar, PhD, D. Garrote, PhD, J. A. Ferron, PhD INTRODUCTION The gold standard treatment for cholelithiasis is cur- rently laparoscopic cholecystectomy (LC). During the learning curve phase, LC bile duct injuries appear to be more numerous and severe than those caused by open cholecystectomy.1 Currently, the biliary complication rate of these 2 procedures is similar.2,3 Complication produced by the sectioning of a nonvisualized duct of Luschka are uncommon during LC, although the true incidence is unknown, especially because published studies focus on so-called major biliary lesions.1,3,4 From 1999 through 2003, we performed 1351 LCs in our department and observed 2 cases (0.15%) of bile leak- age due to duct of Luschka injury. We present these 2 cases and discuss the appropriate diagnostic and ther- apeutic approach. CASE 1 A 51-year-old man was referred to our department for repeated colic abdominal pain in the right hypochon- drium. He had a history of hepatic and renal polycystosis that produced severe chronic renal insufficiency. He un- derwent a surgical laparoscopy that revealed multiple cysts of various sizes on both lobes of the liver. Laparo- scopic defenestration of the dominant hepatic cysts and laparoscopic cholecystectomy were performed. In the postoperative period, the patient was afebrile and expe- rienced diffuse moderate pain of the whole abdomen, with no other symptoms. Two abdominal ultrasound scans showed a small amount of liquid in the abdominal cavity; the blood analysis results were normal. The liquid was assumed to derive from the fenestrated cysts. On the sixth postoperative day, the patient reported the abrupt onset of intense abdominal pain, and a new ultrasound scan showed an increase in the abdominal liquid. An exploratory laparotomy revealed biliary peritonitis due to bile leakage from the duct of Luschka in the liver bed. An intraoperative cholangiography confirmed that the biliary tree was intact. The duct of Luchska was then closed, with thorough lavage of the abdominal cavity. The second postoperative period was free of complications, and the patient was discharged from the hospital 5 days after the second surgery.