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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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References

  1. Ferrucci JT Jr, Mueller PR, Harbin WP (1980) Percutaneous biliary drainage. Radiology 135:1–13

    PubMed  Google Scholar 

  2. Cope C, Marinelli DL, Weinstein JK (1988) Transcatheter biopsy of lesions obstructing the bile ducts. Radiology 169:555–556

    CAS  PubMed  Google Scholar 

  3. Martin EC, Karlson KB, Fankuchen EI (1980) Percutaneous transhepatic dilatation of intrahepatic biliary strictures. AJR Am J Roentgenol 135:836–840

    Google Scholar 

  4. Wittich GR, vanSonnenberg E, Goodacre BW (1998) Radiologic management of hepatolithiasis. Gastroenterologist 6:21–23

    CAS  PubMed  Google Scholar 

  5. Alden ME, Mohiuddin M (1994) The impact of radiation dose in combined external beam and intraluminal Ir-192 brachytherapy for bile duct cancer. Int J Radiat Oncol Biol Phys 28:945–951

    CAS  PubMed  Google Scholar 

  6. Karani J, Fletcher MS, Brinkley D, Dawson JL, Williams R, Nunnerley H (1985) Internal biliary drainage and local radiotherapy with iridium-192 wire in treatment of hilar cholangiocarcinoma. Clin Radiol 36:603–606

    Article  CAS  PubMed  Google Scholar 

  7. Milella M, Salvetti M, Cerrotta A, et al. (1998) Interventional radiology and radiotherapy for inoperable cholangiocarcinoma of the extrahepatic bile ducts. Tumori 84:467–471

    CAS  PubMed  Google Scholar 

  8. Funaki B, Zaleski GX, Straus CA, et al. (1999) Percutaneous biliary drainage in patients with nondilated intrahepatic bile ducts. AJR Am J Roentgenol 173:1541–1544

    CAS  PubMed  Google Scholar 

  9. Iwatsuki S, Starzl TE (1988) Personal experience with 411 hepatic resections. Ann Surg 288:421–434

    Google Scholar 

  10. Belghiti J, Hiramatsu K, Benoist S, et al. (2000) Seven hundred forty-seven hepatectomies in the 1990s: An update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    Article  CAS  PubMed  Google Scholar 

  11. Marcos A (2000) Right lobe donor liver transplantation: A review. Liver Transplant 6:3–20

    CAS  Google Scholar 

  12. Miller AB, Hoogstraten B, Staquet M, et al. (1981) Reporting results of cancer treatment. Cancer 47:207–214

    CAS  PubMed  Google Scholar 

  13. Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed) Evaluation of chemotherapeutic agents, Columbia University Press, pp 191–205

  14. Mueller PR, van Sonnenberg E, Ferrucci JT Jr (1986) Biliary stricture dilatation: Multicenter review of clinical management in 73 patients. Radiology 160:17–22

    CAS  PubMed  Google Scholar 

  15. Parviainen MC, Sand JA, Nordback IH (1996) Coincidence of pancreatic and biliary leakages after pancreaticoduodenal resections. Hepatogastroenterology 43:1246–1249

    CAS  PubMed  Google Scholar 

  16. Greif F, Bronsther OL, Van Thiel DH, et al. (1994) The incidence, timing and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 219:40–45

    CAS  PubMed  Google Scholar 

  17. Buanes T, Waage A, Mjaland O, et al. (1996) Bile leak after cholecystectomy: Significance and treatment. Results from the National Norwegian Cholecystectomy Registry. Int Surg 81:276–279

    CAS  PubMed  Google Scholar 

  18. Lo CM, Fan ST, Liu CL, et al. (1998) Biliary complications after hepatic resection. Arch Surg 133:156–161

    CAS  PubMed  Google Scholar 

  19. Czerniak A, Thompson JN, Soreide O, et al. (1998) The management of fistulas of the biliary tract after injury to the bile duct during cholecystectomy. Surg Gynecol Obstet 167:33–38

    Google Scholar 

  20. Pavone P, Laghi A, Catalano C, et al. (1999) MRI of the biliary and pancreatic ducts. Eur Radiol 9:1513–1522

    Article  CAS  PubMed  Google Scholar 

  21. Ernst O, Asselah T, el Fakir Y, et al. (1997) MR cholangiopancreatography. Ann Chir 51:1111–1114

    CAS  PubMed  Google Scholar 

  22. Vitellas KM, El-Dieb A, Vaswani K, et al. (2001) Detection of bile duct leaks using MR cholangiography with mangfodipir trisodium (Teslascan). J Comput Assist Tomogr 25:102–105

    CAS  PubMed  Google Scholar 

  23. Trerotola SO, Savader SJ, Lund GB, et al. (1992) Biliary tract complications following laparoscopic cholecystectomy: Imaging and intervention. Radiology 184:195–200

    CAS  PubMed  Google Scholar 

  24. Cabada T, Sarria L, Martinez-Berganza MT, et al. (2002) Helical CT cholangiography in the evaluation of biliary tract: Application to the diagnosis of choledocholithiasis. Abdom Imaging 27:61–70

    Google Scholar 

  25. Liguory C, Vitale GC, Lefebre JF, et al. (1991) Endoscopic treatment of postoperative biliary fistulae. Surgery 110:779–784

    CAS  PubMed  Google Scholar 

  26. Marks JM, Ponsky JL, Shillingstad RB, et al. (1998) Biliary stenting is more effective than sphincterectomy in the resolution of biliary leaks. Surg Endosc 12:327–330

    Article  CAS  PubMed  Google Scholar 

  27. Chow S, Bosco JJ, Heiss FW, et al. (1997) Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterectomy. Am J Gastroenterol 92:1839–1843

    CAS  PubMed  Google Scholar 

  28. Ernst O, Sergent G, Mizrahi D, et al. (1999) Biliary leaks: Treatment by means of percutaneous transhepatic biliary drainage. Radiology 211:345–348

    CAS  PubMed  Google Scholar 

  29. Kaufman SL, Kadir S, Mitchell SE, et al. (1985) Percutaneous transhepatic biliary drainage for bile leaks and fistulas. AJR Am J Roentgenol 144:1055–1058

    CAS  PubMed  Google Scholar 

  30. Vaccaro JP, Dorfman GS, Lambiase RE (1991) Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion. Cardiovasc Intervent Radiol 14:109–112

    CAS  PubMed  Google Scholar 

  31. Harris VJ, Kopecky KK, Harman JT, et al. (1993) Percutaneous transhepatic drainage of the nondilated biliary system. J Vasc Interv Radiol 4:591–595

    CAS  PubMed  Google Scholar 

  32. L’Hermine C, Ernst O, Delemazure O, Sergent G (1996) Arterial complication of percutaneous transhepatic biliary drainage. Cardiovasc Intervent Radiol 19:160–164

    CAS  PubMed  Google Scholar 

  33. Audisio R, Bozzetti F, Severini A, et al. (1988) The occurrence of cholangitis after percutaneous biliary drainage: Evaluation of some risk factors. Surgery 103:507–512

    CAS  PubMed  Google Scholar 

  34. Tipaldi L, (1995) A simplified percutaneous hepatogastric drainage technique for malignant biliary obstruction. Cardiovasc Intervent Radiol 18:333–336

    Article  CAS  PubMed  Google Scholar 

  35. Soulez G, Therasse E, Oliva VL, et al. (1997) Left hepaticogastrostomy for biliary obstruction: Long-term results. Radiology 204:780–786

    CAS  PubMed  Google Scholar 

  36. Hunt JA, Gallagher PJ, Heintze SW, et al. (1997) Percutaneous microcoil embolization of intraperitoneal intrahepatic and extrahepatic biliary fistulas. Aust NZ J Surg 67:424–427

    CAS  Google Scholar 

  37. Smith AC, Shapiro RH, Kelsey PB, et al. (1986) Successful treatment of nonhealing biliary-cutaneous fistulas with biliary stents. Gastroenterology 90:764–769

    CAS  PubMed  Google Scholar 

Download references

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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  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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