Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts

Guido Cozzi, Aldo Severini, Enrico Civelli, Marco Milella, Andrea Pulvirenti, Monica Salvetti, Raffaele Romito, Laura Suman, Francesca Chiaraviglio, Vincenzo Mazzaferro

Research output: Contribution to journalArticle

59 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)380-388
Number of pages9
JournalCardioVascular and Interventional Radiology
Volume29
Issue number3
DOIs
Publication statusPublished - Jun 2006

Fingerprint

Intrahepatic Bile Ducts
Drainage
Bile Ducts
Cutaneous Fistula
Cholangitis
Nutritional Support
Biliary Tract
Ambulatory Surgical Procedures
Bile
Fistula
Hospitalization
Catheters
Morbidity
Costs and Cost Analysis
Survival
Liver

Keywords

  • Bile ducts, drainage
  • Bile ducts, injuries
  • Bile ducts, interventional procedure
  • Bile ducts, leakage
  • Biliary complications, treatment
  • Interventional radiology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. / Cozzi, Guido; Severini, Aldo; Civelli, Enrico; Milella, Marco; Pulvirenti, Andrea; Salvetti, Monica; Romito, Raffaele; Suman, Laura; Chiaraviglio, Francesca; Mazzaferro, Vincenzo.

In: CardioVascular and Interventional Radiology, Vol. 29, No. 3, 06.2006, p. 380-388.

Research output: Contribution to journalArticle

Cozzi, Guido ; Severini, Aldo ; Civelli, Enrico ; Milella, Marco ; Pulvirenti, Andrea ; Salvetti, Monica ; Romito, Raffaele ; Suman, Laura ; Chiaraviglio, Francesca ; Mazzaferro, Vincenzo. / Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. In: CardioVascular and Interventional Radiology. 2006 ; Vol. 29, No. 3. pp. 380-388.
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AU - Cozzi, Guido

AU - Severini, Aldo

AU - Civelli, Enrico

AU - Milella, Marco

AU - Pulvirenti, Andrea

AU - Salvetti, Monica

AU - Romito, Raffaele

AU - Suman, Laura

AU - Chiaraviglio, Francesca

AU - Mazzaferro, Vincenzo

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N2 - 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.

AB - 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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