Bile leaks are the most common biliary complication of laparoscopic cholecystectomy. Cholescintigraphy has been utilized in the past to diagnose postoperative bile leaks after open cholecystectomy. However, the sensitivity and specificity of this imaging technique has not been defined or compared to other clinical tests. We have retrospectively studied 30 patients over a 2-yr period who underwent cholescintigraphy for a possible postoperative bile leak. This study reviewed the cholescintigraphy images, clinical presentations, and abdominal ultrasonography/CT scanning. Using a gold standard that consisted of the findings of cholangiography and clinical outcome, we determined the diagnostic accuracy of these tests. Symptoms, laboratory testing, and physical examination were found to be poor predictors for the presence of postoperative bile leaks. Ultrasound and CT imaging were less sensitive and nonspecific. In contrast, cholescintigraphy was found to be quite accurate (83-87%) for predicting the presence of bile leaks after laparoscopic cholecystectomy, as well as other biliary surgeries.