Abstract
Purpose
This study was designed to investigate the benefit of percutaneous interventional management of patients with postoperative bile leak on clinical outcome. Primary study endpoints were closure of the bile leak and duration of percutaneous transhepatic biliary drainage (PTBD) treatment. Secondary study endpoints were necessity of additional CT-guided drainage catheter placement, course of serum CRP level as parameter for inflammation, and patients’ survival.
Methods
Between January 2004 and April 2008, all patients who underwent PTBD placement after upper gastrointestinal surgery were analyzed regarding site of bile leak and previous attempt of operative bile leak repair, interval between initial surgery and PTBD placement, procedural interventional management, course of inflammation parameters, duration of PTBD therapy, PTBD-related complications, and patients’ survival.
Results
Thirty patients underwent PTBD placement for treatment of postoperative bile leaks. In 12 patients (40%), PTBD was performed secondary to a surgical attempt of bile leak repair. Additional percutaneous drainage of bilomas was performed in 14 patients (47%). CRP serum level decreased from 138.1 ± 73.4 mg/l before PTBD placement to 43.5 ± 33.4 mg/l 30 days after PTBD placement. The mean duration of PTBD treatment was 55.2 ± 32.5 days in the surviving patients. In one patient, a delayed stenosis of the bile duct required balloon dilation. Two PTBD-related complications (portobiliary fistula, hepatic artery aneurysm) occurred, which were successfully treated by embolization. Overall survival was 73% (22 patients).
Conclusions
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.
Similar content being viewed by others
References
Shimada M, Matsumata T, Akazawa K et al (1994) Estimation of risk of major complications after hepatic resection. Am J Surg 167:399–403
Lo CM, Fan ST, Liu CL, Lai EC, Wong J (1998) Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg 133:156–161
Testa G, Malago M, Broelseh CE (2001) Complications of biliary tract in liver transplantation. World J Surg 25:1296–1299
Sohn TA, Yeo CJ, Cameron JL et al (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7:209–219
Yanaga K, Kanematsu T, Takenaka K, Sugimachi K (1986) Intraperitoneal septic complications after hepatectomy. Ann Surg 203:148–152
Norton L, Moore G, Eiseman B (1975) Liver failure in the postoperative patient: the role of sepsis and immunologic deficiency. Surgery 78:6–13
Fragulidis G, Marinis A, Polydorou A et al (2008) Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: an algorithmic approach. World J Gastroenterol 14:3049–3053
Ernst O, Sergent G, Mizrahi D, Delemazure O, L’Hermine C (1999) Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology 211:345–348
Kauffman GW, Rau WS, Fiedler L, Wimmer B, Hauenstein KH, Papacharalampous X (1984) After-care problems and complications of percutaneous biliary drainage. Rofo 141:373–378
Winter JM, Cameron JL, Campbell KA et al (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1210 discussion 1210–1211
Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990 s: pathology, complications, and outcomes. Ann Surg 226:248–257 discussion 257–260
Antolovic D, Koch M, Galindo L et al (2007) Hepaticojejunostomy–analysis of risk factors for postoperative bile leaks and surgical complications. J Gastrointest Surg 11:555–561
Pascher A, Neuhaus P (2005) Bile duct complications after liver transplantation. Transpl Int 18:627–642
Binmoeller KF, Katon RM, Shneidman R (1991) Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol 86:227–231
Hoffman BJ, Cunningham JT, Marsh WH (1990) Endoscopic management of biliary fistulas with small caliber stents. Am J Gastroenterol 85:705–707
Liguory C, Vitale GC, Lefebre JF, Bonnel D, Cornud F (1991) Endoscopic treatment of postoperative biliary fistulae. Surgery 110:779–783 discussion 783–784
Goldin E, Katz E, Wengrower D et al (1990) Treatment of fistulas of the biliary tract by endoscopic insertion of endoprostheses. Surg Gynecol Obstet 170:418–423
Nuzzo G, Giuliante F, Giovannini I et al (2008) Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy. Am J Surg 195:763–769
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 14:611–615
Civelli EM, Meroni R, Cozzi G et al (2004) The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience. Eur Radiol 14:579–582
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Stampfl, U., Hackert, T., Radeleff, B. et al. Percutaneous Management of Postoperative Bile Leaks After Upper Gastrointestinal Surgery. Cardiovasc Intervent Radiol 34, 808–815 (2011). https://doi.org/10.1007/s00270-011-0104-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-011-0104-3