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Percutaneous Transhepatic Biliary Drainage in the Management of Postsurgical Biliary Leaks in Patients with Nondilated Intrahepatic Bile Ducts

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Abstract

Purpose

To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity.

Methods

Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts.

Results

Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1–90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external–internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3–118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external–internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed.

Conclusions

PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs.

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Acknowledgments

We thank the radiology technicians and the nurses at the Hepato-pancreatico-biliary Unit for their help in performing the described procedures and for meticulous care of the patients. The editorial assistance of D. Guarneri, M. Gaffo, C. D’Ann, and M. Trotter has been greatly appreciated. This study was supported by the AIRC (Italian Association for Cancer Research).

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Authors and Affiliations

  1. Department of Radiology, Radiologia 3 Unit, National Cancer Institute (Istituto Nazionale Tumori), via Venezian 1, Milan, 20133, Italy

    Guido Cozzi, Aldo Severini, Enrico Civelli, Marco Milella, Monica Salvetti, Laura Suman & Francesca Chiaraviglio

  2. Department of Surgery, Gastrointestinal Surgery and Liver Transplantation Unit, National Cancer Institute (Istituto Nazionale Tumori), Via Venezian 1, Milan, 20133, Italy

    Andrea Pulvirenti, Raffaele Romito & Vincenzo Mazzaferro

Authors
  1. Guido Cozzi
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  2. Aldo Severini
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  3. Enrico Civelli
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  4. Marco Milella
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  5. Andrea Pulvirenti
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  6. Monica Salvetti
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  7. Raffaele Romito
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  8. Laura Suman
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  9. Francesca Chiaraviglio
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  10. Vincenzo Mazzaferro
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Correspondence to Guido Cozzi.

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Cozzi, G., Severini, A., Civelli, E. et al. Percutaneous Transhepatic Biliary Drainage in the Management of Postsurgical Biliary Leaks in Patients with Nondilated Intrahepatic Bile Ducts. Cardiovasc Intervent Radiol 29, 380–388 (2006). https://doi.org/10.1007/s00270-005-0102-4

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