Interventional treatment of biliodigestive anastomosis leaks with a modified percutaneous transhepatic cholangiodrainage

Abstract

IntroductionBiliodigestive leaks are typically caused by an insufficiency at the surgical anastomosis. Biliodigestive anastomosis (BDA) insufficiencies can lead to bilomas, abscesses and vascular erosion in chronic conditions.Material and methodsWe performed a retrospective analysis of the medical and radiological records of all patients with biliodigestive insufficiency who received interventional treatment between July 2015 and February 2021. Nine patients (three with unilateral drainage and six with bilateral drainage) were treated with a modified percutaneous transhepatic cholangiodrainage (PTCD). Clinical success was considered after complete resolution of the peribiliary collections, absence of bile within the surgical drains, radiological patency of the BDA (contrast medium flowing properly through the BDA and no signs of leakage) and haemodynamic stability of the patient without signs of sepsis.ResultsClinical success was achieved in all nine patients. No patients required revision surgery to repair their BDA. The mean indwelling drainage time was 34.8±16.5 days. The mean number of interventional procedures performed per patient was 6.6±2.0.ConclusionPatients who present with BDA insufficiency may benefit from interventional radiological techniques. Our modified PTCD resolved the BDA leak in all nine cases and should be considered as a valuable option for the treatment of patients with this complication. Our technique demonstrated to be feasible and effective.

Role of interventional radiology in the management of postoperative gastrointestinal leakage

“…Retrievable covered stent placement is considered first-line treatment. 55 Complications of stent placement are known to be haemobilia, stent migration, and obstruction of intrahepatic bile ducts. 56 To decompress and drain bile and pancreatic fluid and to reestablish continuity between the biliary system and the digestive system, percutaneous transhepatic biliary drainage insertion with the drainage catheter tip at the small bowel can be carried out.…”