Incidence and Management of Biliary Leakage After Hepaticojejunostomy

Castro, S. M. M. de; Kuhlmann, Koert F. D.; Busch, Olivier R.; Delden, Otto M. van; Laméris, Johan S.; Gulik, Thomas M. van; Obertop, H.; Gouma, Dirk J.

doi:10.1016/j.gassur.2005.08.010

Cited by 105 publications

(86 citation statements)

References 46 publications

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“…More recent small series have shown that PTC and subsequent drainage for a variety of indications can be feasible in patients with nondilated bile ducts as well; the technical success rates were similar to those in patients with dilated bile ducts (91-100%) [17,19,20,21,22,23,24,25,26]. Several studies have described the management of biliary leakage both after hepaticojejunostomy or post-hepatectomy, however a PTBD was performed in the minority of patients [27,28]. To our knowledge, we report the largest study on only PTBD procedures for biliary leakage in a group of exclusively postoperative patients.…”

Section: Introductionmentioning

confidence: 97%

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

Jong¹,

Moelker

Leertouwer

et al. 2013

Dig Surg

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Objective and Background: Bile leakage is a serious postoperative complication and percutaneous transhepatic biliary drainage (PTBD) may be an option when endoscopic treatment is not feasible. In this retrospective study, we established technical and clinical success rates as well as the complication rates of PTBD in a large group of patients with postoperative bile leakage. Methods: Data on all patients with nondilated intrahepatic bile ducts who underwent a PTBD procedure for the treatment of bile leakage between January 2000 and August 2012 were retrospectively assessed. Data included type of surgery, site of bile leak, previous attempts of bile leak repair, interval between surgery and PTBD placement. Outcome measures were the technical and clinical success rates, the procedure-related complications, and mortality rate. Results: A total of 63 patients were identified; PTBD placement was technically successful in 90.5% (57/63) after one to three attempts. The clinical success rate was 69.8% (44/63). Four major complications were documented (4/63; 6.3%): liver laceration, pneumothorax, pleural empyema, and prolonged hemobilia. One minor complication involved pain. Conclusions: PTBD is an effective treatment with low complication rates for the management of postsurgical bile leaks in patients with nondilated bile ducts.

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Section: Introductionmentioning

confidence: 97%

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

Jong¹,

Moelker

Leertouwer

et al. 2013

Dig Surg

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“…In patients undergoing hepatectomy for advanced hepatic hilum malignancy, ag gressive dissection may compromise the ductal blood supply. Peripheral branches of blood vessels, with small diameters and a poor blood supply, may be damaged along with the bile duct, which increases the risk of biliary leakage [1] . The use of stents has been recommended to decompress the bile duct, reduce the risk of bile leakage, and decrease fibrotic narrowing of the anastomosis during early healing [9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…The use of stents has been recommended to decompress the bile duct, reduce the risk of bile leakage, and decrease fibrotic narrowing of the anastomosis during early healing [9][10][11][12] . However, the risk of biliary complications such as leakage or stenosis is increased by the presence of small several bilioenteric anastomoses [1] . We performed placement of a percutaneous transhepatic biliary stent using a 10-Fr BLAKE Silicone Drain connected to a J-VAC Suction Reservoir for the treatment of stenotic hepaticojejunostomy.…”

Section: Discussionmentioning

confidence: 99%

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Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

Yoshida¹,

Mamada²,

Taniai³

et al. 2009

WJG

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“…Successful biliary-enteric anastomosis relies on identification of healthy bile duct mucosa proximal to the stricture, preparation of a Roux-en-Y jejunal loop and direct mucosa-to-mucosa anastomosis between these two structures. Recent analysis of our results in 1,033 hepaticojejunostomies performed for various benign and malignant indications, showed that when adhering to these principles, the outcome of biliary-enteric anastomoses is favorable and the procedure can be done with low morbidity (overall 2.3% biliary leakage) [7]. More specifically in the setting of reconstructive surgery for bile duct injuries, 151 patients were treated using hepaticojejunostomy with an overall complication rate of 26.4%, but with 7.9% complications in patients who were referred without prior biliary interventions [1].…”

Section: Discussionmentioning

confidence: 99%

Laser-Guided Repair of Complex Bile Duct Strictures

Gulik

Beek²,

Reuver³

et al. 2009

Dig Surg

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Background: The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. Aim: We describe a technique to identify the prestenotic bile duct using the sentinel light of a laser fiber passed through the catheter after percutaneous transhepatic biliary drainage (PTD). Methods: Seven patients were seen with hepatic duct or segmental BDS after (extended) right hemihepatectomy (4), cholecystectomy (2) or previous hepaticojejunostomy (1). All patients underwent preoperative PTD for imaging of stricture site and drainage. During operation for repair, a laser fiber (0.2–0.6 mm) connected to a (low-power) red light-emitting diode laser was passed through the PTD catheter into the proximal end of the stricture. Results: In 6 patients, the prestenotic bile duct was identified and exposed with the aid of the sentinel light of the laser fiber. Roux-en-Y hepaticojejunostomy was carried out in all patients. Postoperative cholangiographies showed complete restoration of biliary continuity. In one patient, positioning of the laser fiber failed because of angulation of the PTD catheter. Conclusion: Laser-guided identification of prestenotic bile duct facilitates exposure of the stricture site without unnecessary and usually difficult dissection in complex postoperative BDS.

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Incidence and Management of Biliary Leakage After Hepaticojejunostomy

Cited by 105 publications

References 46 publications

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

Percutaneous Transhepatic Biliary Drainage in Patients with Postsurgical Bile Leakage and Nondilated Intrahepatic Bile Ducts

Placement of percutaneous transhepatic biliary stent using a silicone drain with channels

Laser-Guided Repair of Complex Bile Duct Strictures

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