Skip to main content
Erschienen in: European Radiology 5/2010

01.05.2010 | Interventional

Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results

verfasst von: Vittorio Pedicini, Dario Poretti, Giovanni Mauri, Manuela Trimboli, Giorgio Brambilla, Luca Maria Sconfienza, Gianpaolo Cornalba, Francesco Sardanelli

Erschienen in: European Radiology | Ausgabe 5/2010

Einloggen, um Zugang zu erhalten

Abstract

Objective

To compare the outcome of patients affected by biliary leak after major biliary surgery and treated with percutaneous transhepatic biliary drainage (PTBD) alone with that of similar patients treated with PTBD and concurrent positioning of an occlusion balloon (PTBD-OB).

Methods

We retrospectively reviewed the results of the use of PTBD or PTBD-OB performed at our institution from 2004 to 2008 in patients with post-surgical biliary leak. Sixteen patients entered the evaluation. PTDB alone was performed in 9 men (age 59.7 ± 13.4 years [mean ± standard deviation]; median 60 years), while PTBD-OB was performed in 7 patients (5 men, 2 women, age 71.3 ± 9.3 years; median 68 years).

Results

No significant difference between groups was found regarding age (p = 0.064) and sex (p = 0.175) distribution, number of procedures (3.1 ± 1.62; 2 vs 1.7 ± 1.1; 1, p = 0.151), and days of disease before recovery, death or modification of treatment (51.6 ± 66.8; 23 vs 18.6 ± 15.1; 14, p = 0.266). The number of patients treated with PTBD-OB who fully recovered (7/7, 100%) was significantly higher than that of patients treated with PTBD alone (4/9, 44%, p = 0.034).

Conclusion

This procedure appears to be clinically effective, being associated with a higher probability of recovery in patients treated for post-surgical biliary leak. Further studies are needed to confirm these preliminary results.
Literatur
1.
2.
Zurück zum Zitat Pace RF, Blenkharn JI, Edwards WJ et al (1989) Intra-abdominal sepsis after hepatic resection. Ann Surg 209:302–306CrossRefPubMed Pace RF, Blenkharn JI, Edwards WJ et al (1989) Intra-abdominal sepsis after hepatic resection. Ann Surg 209:302–306CrossRefPubMed
3.
Zurück zum Zitat Lam CM, Lo CM, Liu CL et al (2001) Biliary complications during liver resection. World J Surg 25:1273–1276CrossRefPubMed Lam CM, Lo CM, Liu CL et al (2001) Biliary complications during liver resection. World J Surg 25:1273–1276CrossRefPubMed
4.
Zurück zum Zitat Righi D, Franchello A, Ricchiuti A et al (2008) Safety and efficacy of the percutaneous treatment of bile leaks in hepaticojejunostomy or split-liver transplantation without dilatation of the biliary tree. Liver Transpl 14:611–615CrossRefPubMed Righi D, Franchello A, Ricchiuti A et al (2008) Safety and efficacy of the percutaneous treatment of bile leaks in hepaticojejunostomy or split-liver transplantation without dilatation of the biliary tree. Liver Transpl 14:611–615CrossRefPubMed
5.
Zurück zum Zitat Kaffes AJ, Hourigan L, De Luca N et al (2005) Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc 61:269–275CrossRefPubMed Kaffes AJ, Hourigan L, De Luca N et al (2005) Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc 61:269–275CrossRefPubMed
6.
Zurück zum Zitat Sandha GS, Bourke MJ, Haber GB et al (2004) Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc 60:567–574CrossRefPubMed Sandha GS, Bourke MJ, Haber GB et al (2004) Endoscopic therapy for bile leak based on a new classification: results in 207 patients. Gastrointest Endosc 60:567–574CrossRefPubMed
7.
Zurück zum Zitat Lee CS, Liu NJ, Lee CF et al (2008) Endoscopic management of biliary complications after adult right-lobe living donor liver transplantation without initial biliary decompression. Transplant Proc 40:2542–2545CrossRefPubMed Lee CS, Liu NJ, Lee CF et al (2008) Endoscopic management of biliary complications after adult right-lobe living donor liver transplantation without initial biliary decompression. Transplant Proc 40:2542–2545CrossRefPubMed
8.
Zurück zum Zitat Cozzi G, Severini A, Civelli E et al (2006) Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 29:380–388CrossRefPubMed Cozzi G, Severini A, Civelli E et al (2006) Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 29:380–388CrossRefPubMed
9.
Zurück zum Zitat Kim JH, Ko GY, Sung KB et al (2008) Bile leak following living donor liver transplantation: clinical efficacy of percutaneous transhepatic treatment. Liver Transpl 14:1142–1149CrossRefPubMed Kim JH, Ko GY, Sung KB et al (2008) Bile leak following living donor liver transplantation: clinical efficacy of percutaneous transhepatic treatment. Liver Transpl 14:1142–1149CrossRefPubMed
10.
Zurück zum Zitat Baker TA, Aaron JM, Borge M et al (2008) Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 195:386–390CrossRefPubMed Baker TA, Aaron JM, Borge M et al (2008) Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 195:386–390CrossRefPubMed
11.
Zurück zum Zitat Yang JH, Shih JC, Liu KL et al (2007) Combined treatment with temporary intraoperative balloon occlusion of common iliac arteries and hysteroscopic endocervical resection with postoperative cervical balloon for intractable cervical pregnancy in an infertile woman. Fertil Steril 88:1438.e11–1438.e13CrossRef Yang JH, Shih JC, Liu KL et al (2007) Combined treatment with temporary intraoperative balloon occlusion of common iliac arteries and hysteroscopic endocervical resection with postoperative cervical balloon for intractable cervical pregnancy in an infertile woman. Fertil Steril 88:1438.e11–1438.e13CrossRef
12.
Zurück zum Zitat Karvonen J, Gullichsen R, Laine S et al (2007) Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. Surg Endosc 21:1069–1073CrossRefPubMed Karvonen J, Gullichsen R, Laine S et al (2007) Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. Surg Endosc 21:1069–1073CrossRefPubMed
13.
Zurück zum Zitat Winter JM, Cameron JL, Yeo CJ (2008) Duodenojejunostomy leaks after pancreaticoduodenectomy. J Gastrointest Surg 12:263–269CrossRefPubMed Winter JM, Cameron JL, Yeo CJ (2008) Duodenojejunostomy leaks after pancreaticoduodenectomy. J Gastrointest Surg 12:263–269CrossRefPubMed
14.
Zurück zum Zitat Grobmyer SR, Pieracci FM, Allen PJ (2007) Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 204:356–364CrossRefPubMed Grobmyer SR, Pieracci FM, Allen PJ (2007) Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 204:356–364CrossRefPubMed
15.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257CrossRefPubMed Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257CrossRefPubMed
16.
Zurück zum Zitat Vin Y, Sima CS, Getrajdman GI et al (2008) Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 207:490–498CrossRefPubMed Vin Y, Sima CS, Getrajdman GI et al (2008) Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 207:490–498CrossRefPubMed
17.
Zurück zum Zitat Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406CrossRefPubMed Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406CrossRefPubMed
18.
Zurück zum Zitat Aytekin C, Boyvat F, Harman A (2007) Percutaneous management of anastomotic bile leaks following liver transplantation. Diagn Interv Radiol 13:101–104PubMed Aytekin C, Boyvat F, Harman A (2007) Percutaneous management of anastomotic bile leaks following liver transplantation. Diagn Interv Radiol 13:101–104PubMed
19.
Zurück zum Zitat Ernst O, Sergent G, Mizrahi D (1999) Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology 211:345–348PubMed Ernst O, Sergent G, Mizrahi D (1999) Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology 211:345–348PubMed
20.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL et al (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7(2):209–219CrossRefPubMed Sohn TA, Yeo CJ, Cameron JL et al (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7(2):209–219CrossRefPubMed
21.
Zurück zum Zitat Kaufman SL, Kadir S, Mitchell SE et al (1985) Percutaneous transhepatic biliary drainage for bile leaks and fistulas. AJR Am J Roentgenol 144:1055–1058PubMed Kaufman SL, Kadir S, Mitchell SE et al (1985) Percutaneous transhepatic biliary drainage for bile leaks and fistulas. AJR Am J Roentgenol 144:1055–1058PubMed
22.
Zurück zum Zitat Burke DR, Lewis CA, Cardella JF et al (2003) Society of interventional radiology standards of practice committee. quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 14:S243–S246PubMed Burke DR, Lewis CA, Cardella JF et al (2003) Society of interventional radiology standards of practice committee. quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 14:S243–S246PubMed
23.
Zurück zum Zitat Weber A, Gaa J, Rosca B et al (2008) Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol. Epub Oct 14. doi:10.1016/j.ejrad.2008.08.012 Weber A, Gaa J, Rosca B et al (2008) Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol. Epub Oct 14. doi:10.​1016/​j.​ejrad.​2008.​08.​012
24.
Zurück zum Zitat Smith AC, Shapiro RH, Kelsey PB et al (1986) Successful treatment of nonhealing biliary-cutaneous fistulas with biliary stents. Gastroenterology 90:764–769PubMed Smith AC, Shapiro RH, Kelsey PB et al (1986) Successful treatment of nonhealing biliary-cutaneous fistulas with biliary stents. Gastroenterology 90:764–769PubMed
25.
Zurück zum Zitat Vaccaro JP, Dorfman GS, Lambiase RE (1991) Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion. Cardiovasc Intervent Radiol 14:109–112CrossRefPubMed Vaccaro JP, Dorfman GS, Lambiase RE (1991) Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion. Cardiovasc Intervent Radiol 14:109–112CrossRefPubMed
26.
Zurück zum Zitat Trerotola SO, Savader SJ, Lund GB et al (1992) Biliary tract complications following laparoscopic cholecystectomy: imaging and intervention. Radiology 184:195–200PubMed Trerotola SO, Savader SJ, Lund GB et al (1992) Biliary tract complications following laparoscopic cholecystectomy: imaging and intervention. Radiology 184:195–200PubMed
27.
Zurück zum Zitat Hunt JA, Gallagher PJ, Heintze SW et al (1997) Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas. Aust NZ J Surg 67:424–427CrossRef Hunt JA, Gallagher PJ, Heintze SW et al (1997) Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas. Aust NZ J Surg 67:424–427CrossRef
28.
Zurück zum Zitat Funaki B, Zaleski GX, Straus CA et al (1999) Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts. AJR Am J Roentgenol 173:1541–1544PubMed Funaki B, Zaleski GX, Straus CA et al (1999) Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts. AJR Am J Roentgenol 173:1541–1544PubMed
Metadaten
Titel
Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results
verfasst von
Vittorio Pedicini
Dario Poretti
Giovanni Mauri
Manuela Trimboli
Giorgio Brambilla
Luca Maria Sconfienza
Gianpaolo Cornalba
Francesco Sardanelli
Publikationsdatum
01.05.2010
Verlag
Springer-Verlag
Erschienen in
European Radiology / Ausgabe 5/2010
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1637-6

Weitere Artikel der Ausgabe 5/2010

European Radiology 5/2010 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.