Leakage of Hepaticojejunal Anastomosis: Radiological Interventional Therapy

Abstract

Background: Hepaticojejunostomy is an established procedure accompanying liver resection as well as hepatobiliary and pancreatic surgery. Typical complications requiring radiological intervention are abscesses and anastomosis leakage. Biliary obstruction and strictures are less frequent indications for interventional radiology since many of them can be treated endoscopically. Methods: Depending on anatomic location, underlying etiology, and complication of leakage, different procedures of interventional radiology are performed: treating abscesses through percutaneous abscess drainage (PAD), handling biliary leakage by percutaneous transhepatic biliary drainage (PTBD) after percutaneous transhepatic cholangiography (PTC), or rarely performed percutaneous stent implantation and internalization after PTC and PAD to treat biliary strictures or to cover the leak. A selective literature search was performed, taking into account recent papers of radiological interventions concerning leakage of hepaticojejunostomy. Results: Different radiological interventions for the treatment of potentially devastating complications after hepaticojejunostomy are recommended. PAD and PTBD serve either as a definite treatment or as bridging therapy until re-surgery is performed. Complications mainly concern uncontrollable bleeding during the intervention. Conclusion: Radiological interventions are safe and usable if the indication is meticulously chosen. PAD is one of the most commonly performed procedures by interventional radiologists and a well-established and safe procedure. PTC, PTBD, and biliary stent implantation are important procedures which are required if endoscopic interventions failed or cannot be performed due to postoperatively changed anatomical structures.

Biliary injuries after pancreatic surgery: interventional radiology management

“…Biliary leakage may originate from injury of the bile ducts, or from anastomotic leakage after bilio-enteric anastomosis. Literature shows an incidence from 2% to 10% after pancreatic surgery without iatrogenic biliary injury; if biliary injury occurred incidence may rise up to 24% ( Table 1) (1,3,4,(11)(12)(13)(14)(15). A multivariate analysis has shown that there are no independent risk factors to predict bile leakage (4).…”

“…Site of puncture should be as peripheral as possible because central puncture have higher risk for major vascular injury. The cholangiography is decision-making to plan treatment (11,17).…”

“…PTBD is the only endoluminal treatment option for biliary leakage when duodenum and common bile duct cannot be cannulated. It gives the opportunity to create a low-pressure system along the biliary tract, redirect the bile flow from the defect into the bile ducts allowing the leak to heal, to avoid further surgery or as a bridging therapy while stabilizing the patient's condition prior to surgery (11).…”

“…Since the 1970's, when the first image-guided percutaneous abscess drainage (PAD) was performed, there was a constant development of technical advices and techniques, leading to more treatment opportunities and better outcomes in interventional radiology (IR). To date radiological interventions play a pivotal rule and are considered the first-line management of postoperative complications optimizing the patient's condition often resulting in a definitive treatment (5)(6)(7)11).…”

Management of Complications after Major Gastrointestinal Surgery

“…May and Hunold [3] report on rarely performed radiological interventions such as percutaneous transhepatic biliary drainage or stent in the case of anastomotic leakages of hepaticojejunal anastomoses.…”