Percutaneous Management of Postoperative Bile Leaks After Upper Gastrointestinal Surgery

Hackert, T.; Radeleff, Boris; Sommer, Christof M.; Stampfl, Sibylle; Werner, Jens; Büchler, Markus W.; Kauczor, Hans Ulrich; Richter, G. M.

doi:10.1007/s00270-011-0104-3

Cited by 37 publications

(26 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On the other hand, successful percutaneous management of bile leaks requires long therapy courses. An average duration of PTBD treatment of 6 weeks to 80 days has been reported [14,18]. As seen in our series, Onyx application for the management of bile leaks can shorten therapy courses substantially when combined with PTBD.…”

supporting

confidence: 59%

“…In these situations, PTBD represents the approach of choice and provides a considerable reduction in repeated laparotomies. Recently, less invasive methods, such as PTBD combined with percutaneous drainage of bilomas, were successfully performed [14,15]. Surgical treatment is required when conservative endoscopic and radiological management fails and can be performed by liver resection, bile duct reconstruction or bilioenteric anastomosis [16,17].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Uller

Müller-Wille

Loss

et al. 2013

Fortschr Röntgenstr

View full text Add to dashboard Cite

Purpose: The management of postoperative bile leakage is challenging especially if the leak rises from the cut surface of the liver and endoscopic treatment fails. Percutaneous transhepatic treatment of bile leaks with biliary drainage is accepted but often requires long-term placement of the drains and is associated with treatment failures. This series evaluates selective embolization of bile ducts with an ethylene vinyl alcohol copolymer (Onyx) in patients with postoperative bile leaks as an alternative treatment option. Materials and Methods: Between January and September 2012, five consecutive patients with persistent postoperative bile leaks underwent percutaneous transhepatic Onyx application and were analyzed regarding procedural management, complications and success rates. Results: The persistent bile leaks were situated at the cystic stump (after cholecystectomy, n?=?2), at the cut surface of the liver (after extended liver resection, n?=?2) and at the surface of the liver after surgical exploration and perihepatic abscess (n?=?1). Bile drainage alone (endoscopic or percutaneous) failed in all patients and open redo-surgery was deemed potentially harmful. Bilomas were externally drained in all patients before Onyx application. For the closure of bile leaks, Onyx was injected through a microcatheter in a previously built coil nest to keep Onyx in place. All bile leaks were initially closed immediately. In the 2nd week after Onyx embolization, 2 patients showed recurrent small bile leaks without clinical symptoms. In the 4th week after Onyx application, all leaks were closed. No complications occurred. Conclusion: All leaking bile ducts were initially closed immediately after Onyx application. In the 2nd week after Onyx application, 2 patients showed small bile leaks without clinical symptoms. All leaks were closed in the 4th week after Onyx application. Key Points: Percutaneous treatment of postoperative bile leaks with Onyx seems to be an effective therapy if endoscopy fails and redo-surgery is deemed harmful. Citation Format:

show abstract

supporting

confidence: 59%

mentioning

confidence: 99%

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Uller

Müller-Wille

Loss

et al. 2013

Fortschr Röntgenstr

View full text Add to dashboard Cite

show abstract

“…In patients with nondilated peripheral bile ducts at ultrasound, the puncture was performed under fluoroscopic guidance using cholangiography (obtained via the drainage catheter near the leak site or surgical T-tube). Furthermore, in some studies the puncture site was usually more central when the bile ducts were nondilated, as this facilitates the puncture [21,22,26]. Also, Funaki et al [17] reported a higher number of passes in patients with nondilated bile ducts.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this study encompassed the largest time span and sample size of its kind. Over the last 20 years a number of small studies in at least 10 patients also reported high technical success rates (91-100%), high clinical success rates (70-100%), and low major complication rates (0-13%) [8,19,21,22,25,26,30]. …”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Jong¹,

Moelker

Leertouwer

et al. 2013

Dig Surg

View full text Add to dashboard Cite

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.

show abstract

Clinical significance of liver ischaemia after pancreatic resection

Hackert

Stampfl

Schulz

et al. 2011

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

Percutaneous Management of Postoperative Bile Leaks After Upper Gastrointestinal Surgery

Abstract: PTBD treatment is an effective therapy. PTBD treatment and additional CT-guided drainage of bilomas helped to reduce intraabdominal inflammation, as shown by reduction of inflammation parameters.

Cited by 37 publications

References 15 publications

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

Percutaneous Management of Postoperative Bile Leaks with an Ethylene Vinyl Alcohol Copolymer (Onyx)

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

Clinical significance of liver ischaemia after pancreatic resection

Contact Info

Product

Resources

About