Percutaneous Transhepatic Balloon Dilation of Biliary-Enteric Anastomotic Strictures after Surgical Repair of Iatrogenic Bile Duct Injuries

Abstract

PurposeTo evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries.Material and MethodsA total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity.ResultsBalloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%). Anastomotic stricture recurred in one of 21 patients (5%) after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p = 0.02) and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p = 0.02) than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p = 0.17) or in the maximum balloon diameter used (p = 0.99) were demonstrated for patients with successful or unsuccessful balloon dilation outcomes.ConclusionPercutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis.

Asia-Pacific consensus guidelines for endoscopic management of benign biliary strictures

“…75 Percutaneous transhepatic biliary drainage followed by balloon dilation is a minimally invasive, safe, and effective option, offering the patient a quicker recovery and far less morbidity than surgery. 76 Prospective data showed that percutaneous catheter placement for 6 to 8 months in extrahepatic, single-site, biliary strictures, with progressive catheter insertion upsizing to 18F to 20F, was effective and achieved stricture resolution in 64% of patients with post-liver transplantation biliary strictures and in 86.4% of patients with BBSs with other etiologies. 77 Percutaneous transhepatic placement of retrievable covered metal stents also appeared feasible for the treatment of BBSs, with satisfied short-term or mid-term outcomes.…”

Biliary injuries after pancreatic surgery: interventional radiology management

“…Anastomotic stricture is defined as a radiologically demonstrated narrowing of the biliary-enteric anastomosis associated with symptoms (jaundice, cholangitis or deranged liver function tests) requiring percutaneous, endoscopic or surgical treatment (3,29). Post-operative biliary stricture usually presented on an average period of 2.3 years (range, 0-15.3 years) after surgery, without any relationship with the nature of the primary disease (29,30).…”

“…The clinical success rate of PTC with balloon dilation as a first line treatment is from 66% to 87% (Table 4) (30)(31)(32)(33)(34)(35).…”

Complex percutaneous biliary procedures: Review and contributions of a high volume team

“…The first line of treatment is the balloon dilation first described by Molnar and Stockum 55 in 1978, a simple practice with a success rate surrounding 60% depending on the series. [56][57][58][59][60][61][62][63] The balloon dilation procedure is not a very complicated one. Over the previous biliary drainage, the guide wire advances and the withdraw of the catheter takes places.…”