Management strategies for bile leaks after cholecystectomy: a narrative review

Background and Objective: Bile leaks complicate approximately 0.5% of cholecystectomies and result in significant morbidity. While advances in interventional radiology, endoscopy, and surgery have taken place, the rate of minor bile leaks has remained constant. The aim of this review is to provide a comprehensive evaluation of contemporary bile leak management with emphasis on timing, sequencing, and selection of both diagnostic and therapeutic interventions.Methods: A narrative review was performed with a predefined search strategy. PubMed was evaluated for relevant articles published between January 1, 2000 and August 9, 2025. Studies were included if they were published in English and involved human subjects; case reports were excluded. Additional articles were identified by reviewing the reference lists of included studies and performing targeted supplementary searches to address topics not captured in the initial database search.Key Content and Findings: Management of bile leaks after cholecystectomy can follow a principle-based, step-up approach. The primary focus of initial care includes (I) leak recognition, (II) resuscitation and antibiotic administration, and (III) imaging and source control. This is followed by therapeutic interventions that include both non-operative and operative techniques. Particular attention is paid to percutaneous, endoscopic, and surgical interventions. Escalation of care is directed by leak severity, patient acuity, anatomic considerations, resource availability, and provider experience.Conclusions: Bile leaks after cholecystectomy require early recognition, coordinated interdisciplinary care, and timely interventions for effective management. This review provides a principle-based framework for providers to develop tailored management strategies for their patients and highlights areas for future study moving forward.