Biliary Leaks: Treatment by Means of Percutaneous Transhepatic Biliary Drainage

Ernst, Olivier; Sergent, Géraldine; Mizrahi, Didier; Delemazure, O; L’Herminé, C

doi:10.1148/radiology.211.2.r99ma30345

Cited by 67 publications

(32 citation statements)

References 15 publications

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“…Although not attempted here, a recent report indicates that percutaneous transhepatic biliary drainage is particularly useful in cases in which surgical or endoscopic management has failed. 19 In the present study, reoperation resulting from postoperative bile leakage was complicated by dense adhesions 20 that rendered dissection and identification of the leakage site difficult; this was particularly true in patients in whom the decision to reoperate was made late in the postoperative period. The traumatization of many different tissues and the associated bleeding aggravate hepatic failure and lead to a dismal prognosis.…”

Section: Discussionmentioning

confidence: 74%

Bile Leakage After Hepatic Resection

et al. 2001

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ObjectiveTo identify the perioperative risk factors for postoperative bile leakage after hepatic resection, to evaluate the intraoperative bile leakage test as a preventive measure, and to propose a treatment strategy for postoperative bile leakage according to the outcome of these patients. Summary Background DataBile leakage remains a common cause of major complications after hepatic resection. MethodsBetween January 1985 and June 1999, 781 hepatic resections without bilioenteric anastomosis were performed at the authors' institution. Perioperative risk factors related to postoperative bile leakage were identified using univariate and multivariate analysis. The characteristics of patients with intractable bile leakage and the effect of intraoperative bile leakage test were also examined. Management was evaluated in relation to the outcomes and the clinical characteristics of the patients with bile leakage. ResultsBile leakage developed in 31 (4.0%) of 781 hepatic resections. This complication carried high risks for surgical death (two patients [6.5%] died). The stepwise logistic regression analysis identified high-risk surgical procedure, in which the cut surface exposed the major Glisson's sheath and included the hepatic hilum (i.e., anterior segmentectomy, central bisegmentectomy, or total caudate lobectomy), as the independent predictor of the development of postoperative bile leakage. None of the 102 cases in which an intraoperative bile leakage test was performed were subsequently complicated by postoperative bile leakage, and the preventive effect of the test was statistically significant. Patients with fisterographically demonstrable leakage from the hepatic hilum and with postoperative uncontrollable ascites had poor outcomes. ConclusionPatients with bile leakage from the hepatic hilum and postoperative uncontrollable ascites tend to have a poor prognosis. Therefore, especially when a high-risk surgical procedure is performed in patients with liver cirrhosis, more careful surgical procedures and use of an intraoperative bile leakage test are recommended.Because of recent advances in liver surgery, hepatic resections are being performed with increasing frequency, and the surgical death rate for such resections is decreasing. [1][2][3][4][5][6][7] Bile leakage, of course, is the primary complication occurring after liver surgery, and it can not only debase the quality of the postoperative course of patients, but also can lead to hospital death. Despite a significant decrease in the overall surgical complication rate in hepatic resections, the rate of bile leakage has not changed, with an incidence of 4.8% to 7.6% reported in recent large series.2-8 The presence of bile, blood, and devitalized tissues in the dead space after hepatectomy may provide the ideal environment for bacterial growth and impair the normal host defense mechanisms.9, 10 The combination of sudden reduction in the liver volume and development of an intraperitoneal septic complication after hepatectomy (IPSCH) frequently results in live...

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Section: Discussionmentioning

confidence: 74%

Bile Leakage After Hepatic Resection

et al. 2001

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“…The success rate and long term results of percutaneous treatment of benign strictures are reviewed and discussed in a number of articles 1,5,7,9,[11][12][13][14][15][16] . The percutaneous treatment of these strictures by dilatation has a success rate from 60 to 90 % 1 .…”

Section: Long-term Resultsmentioning

confidence: 99%

“…Under aseptic conditions, either from the right intercostal or subxiphysternal approach, access is gained to the biliary system. A right or left approach for the biliary drainage is chosen depending on the biliary anatomy, bile leak topography and possibility of puncturing a dilated intrahepatic duct 7 . After gaining access to the biliary system, cholangiography is performed to assess the stenosis (Fig.…”

Section: Techniquementioning

confidence: 99%

Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

Thomas¹,

Köcher²

2007

BIOMED PAP

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Background: Benign biliary strictures are usually treated surgically or endoscopically. When these strictures are not accessible by endoscope or when open repair is not possible, percutaneous dilatation treatment is indicated. The effi cacy of treatment is usually evaluated by clinical trial which includes leaving a small non-functional catheter in situ and following liver function tests. The evaluation may be eff ectively done by the biliary manometric perfusion test.Aim: The aim of this paper is to emphasize the importance of percutaneous dilatation treatment of benign biliary strictures with focus on the role of the biliary manometric perfusion test and its future prospects.Methods and Results: Based on the literature and our own experience, this article gives a short overview of percutaneous treatment of benign biliary strictures, indications, techniques, complications and results. The treatment of these strictures has an overall success rate between 60 to 90 %. This article also explains the biliary manometric test, the technique and its importance in evaluation of treatment success.Conclusion: Benign biliary strictures of the hepatic duct junction or bilio-enteric anastomosis are diffi cult to treat surgically and are endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long term externalinternal drainage is feasible in the majority of these patients. It is minimally invasive, safe and eff ective. The evaluation of the treatment success may be more eff ectively done by the manometric perfusion test. It is easy, reliable, less time-consuming giving immediate results, and relatively safe.

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“…Percutaneous drainages, placed with a sonographic guide, are used to drain the bile collection. Endoscopic or percutaneous transhepatic management, with placement of large-size biliary catheters, allows achievement of good results in the treatment of large BL in adult patients, avoiding surgical repair in many cases [54][55][56][57][58] . In selected patients, when prior endoscopic or percutaneous transhepatic attempts to stent the biliary tree have failed, the combined transhepaticendoscopic approach (rendezvous technique) can be successfully used to place large-size biliary catheters [59][60] .…”

Section: Bile Leakage (Bl)mentioning

confidence: 99%

Interventional radiology procedures in adult patients who underwent liver transplantation

Miraglia

Maruzzelli

Caruso

et al. 2009

WJG

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Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

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Biliary Leaks: Treatment by Means of Percutaneous Transhepatic Biliary Drainage

Abstract: Biliary leaks can be treated successfully by means of percutaneous transhepatic biliary drainage. The procedure is particularly useful when surgical or endoscopic management has failed.

Cited by 67 publications

References 15 publications

Bile Leakage After Hepatic Resection

Bile Leakage After Hepatic Resection

Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

Interventional radiology procedures in adult patients who underwent liver transplantation

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