Percutaneous transhepatic biliary drainage for bile leaks and fistulas

Sl, Kaufman; Kadir, Saadoon; Mitchell, SE; Chang, Randy O.; Kinnison, M L; Cameron, J L; Ri, White

doi:10.2214/ajr.144.5.1055

Cited by 66 publications

(27 citation statements)

References 19 publications

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“…The main causes of biliary leak are bile duct injury during laparoscopic cholecystectomy [2,3], hepaticojejunal anastomosis [5], common bile duct-to-common bile duct anastomosis associated with liver transplantation [3], and hepatic lobectomy [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been advocated widely in small biliary leaks as an alternative to surgery [2][3][4]6]. When endoscopic insertion of a stent can be achieved, a definitive closure of the leak is attained with a frequency ranging from 75 % [2] to 100 % [7,8].…”

Section: Endoscopic Interventionmentioning

confidence: 99%

“…Hepaticojejunal anastomosis is another procedure commonly used to treat biliary leaks. At a later stage of the disease, surgical re-exploration is often difficult because of infection, edema, and scarring in the periportal area [2,4,6]. Furthermore, when the leak involves the intrahepatic ducts, hepatic lobectomy is sometimes required [9].…”

Section: Surgical Interventionmentioning

confidence: 99%

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Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Popat¹,

Thakkar²,

Deshmukh³

et al. 2016

Indian J Surg

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The aim of this study was to evaluate the efficacy of percutaneous transhepatic biliary drainage (PTBD) in the treatment of post-surgical biliary leaks and its efficacy in restoring the integrity of bile ducts. One hundred and fifty-seven patients with a post-surgical biliary leak were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to laparoscopic procedures in 114 patients, while 43 patients had postoperative leak following open surgery. Percutaneous transhepatic biliary drainage was performed with an 8-to 10-F catheter, with the side holes positioned proximal to the site of extravasation to divert bile flow away from the leak site. The established biliary leaks at the site of origin were diagnosed at an average of 7 days (range 2-150 days) after surgery. In all cases, percutaneous access to the biliary tree was achieved. In 62 patients, biliary leak completely healed after drainage for 10-50 days (mean, 28 days) while 89 patients underwent surgical reconstruction subsequently. PTBD is a feasible, effective, and safe procedure for the treatment of post-surgical biliary leaks. It is therefore a reliable alternative to surgically repair smaller biliary leaks, while in patients with large defects, it helps prepare patients for surgical reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Endoscopic Interventionmentioning

confidence: 99%

Section: Surgical Interventionmentioning

confidence: 99%

See 1 more Smart Citation

Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Popat¹,

Thakkar²,

Deshmukh³

et al. 2016

Indian J Surg

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“…Percutaneous transhepatic drainage has been attempted in the treatment of bile duct fistulae [3]. During the last few years, successful endoscopic management of postoperative biliary fistulae have been reported [4][5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Corrective surgery is usually needed to relieve biliary fistulae [2]. Percutaneous transhepatic treatment has been attempted but it is accompanied by complications such as bleeding or it can be technically difficult to perform [3]. This is a report on five cases with postoperative biliary fistulae or leak which were related to retained bile duct stones in four and retained hydatid cysts in CBD in the fifth case.…”

mentioning

confidence: 99%

Endoscopic Biliary Drainage of Postoperative Biliary Fistulae and Leak

1992

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Five consecutive patients with postoperative biliary fistulae or leak were diagnosed and treated successfully by endoscopic intervention. The development of the fistulae were related to distal common bile duct obstruction by stones in four patients and in one patient by hydatid daughter cysts. Endoscopic sphincterotomy with stone or cyst extractions achieved decompression of the biliary system and initiated closure of the fistulae. In two patients, nasobiliary tube was used and endoscopic endoprosthesis was needed to close the fistula in another patient. In such cases, endoscopic management seems to be superior to surgical re-intervention for repair of fistulae or leak.

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Endoscopic management of postoperative bile leaks

Mortensen

Kruse

1992

British Journal of Surgery

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Thirty-two patients aged 15-89 years developed postoperative bile leakage. Twenty-eight had undergone cholecystectomy, with choledocholithotomy in 11, and four had had miscellaneous operations. Endoscopic retrograde cholangiopancreatography (ERCP) was performed 2-75 days after operation and revealed leakage from the cystic duct stump in 19 cases, from a T tube track in five, from the gallbladder and liver abscess cavity in two and from the major bile ducts in six. Major bile duct lesions were not generally amenable to endoscopic treatment, but the remaining 26 patients were treated successfully with internal stenting (22) or endoscopic sphincterotomy (four); bile secretion in all cases stopped within 1 week. One patient with cholangitis after an ERCP procedure was managed by antibiotics; no other complication occurred and there were no deaths related to the procedure. ERCP procedures are well tolerated in the postoperative period and may be performed under sedation. ERCP is the method of choice for dealing with bile leakage and ERCP procedures are effective for the most common causes of postoperative bile leakage; complications are rare.

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Percutaneous transhepatic biliary drainage for bile leaks and fistulas

Cited by 66 publications

References 19 publications

Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Endoscopic Biliary Drainage of Postoperative Biliary Fistulae and Leak

Endoscopic management of postoperative bile leaks

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