Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Popat, Bhavesh; Thakkar, Dev; Deshmukh, Hemant; Rathod, Krantikumar

doi:10.1007/s12262-015-1418-1

Cited by 17 publications

(15 citation statements)

References 11 publications

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“…TS rates of PTBD for biliary leak are reported to be 40-100% without secondary surgery ( Table 2 ) [ 5 , 8 , 18 , 19 ]. The wide range of success rates is attributable to the use of different interventional strategies ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery

Angileri

Rodà

Savoldi

et al. 2020

aog

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Background The aim of this study was to evaluate the diagnosis and management of postoperative bile leaks, reporting typical diagnostic findings and available percutaneous techniques in association with other diagnostic and management methods. Methods Thirty-six patients (28 male) were treated for postoperative bile leaks. A biliary leak was clinically suspected in case of persistent leakage of bilious material from a surgical drain, or in the presence of non-specific symptoms such as abdominal pain, fever and anorexia, with or without laboratory alteration of liver enzymes. Radiological confirmation was mainly based on noninvasive methods such as ultrasound, computed tomography, and magnetic resonance cholangiopancreatography. We assessed each treatment by evaluating multiple factors, including technical success (TS) and clinical effectiveness (CE), defined as primary or secondary. We also evaluated overall CE (OCE), defined as leak control with either single or multiple procedures. Results TS and OCE were achieved in all patients (36/36; 100%) with a grade A or B biliary leak. No grade C was observed. There were no major complications. Minor complications were observed in 7/36 (19.4%) patients. No procedure-related deaths occurred. Conclusions In our study, considering all percutaneous techniques, leak healing was achieved in all the patients with a grade A or B biliary leak. These procedures provide a less invasive approach and are increasingly recognized as having a significant role in the management of complications and should be considered as an integral component in the postoperative management of these patients.

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Section: Discussionmentioning

confidence: 99%

Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery

Angileri

Rodà

Savoldi

et al. 2020

aog

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“…The intrahepatic bile ducts were dilated in 17 patients (11%) and non-dilated in 140 patients (89%) (22). Mastier et al…”

Section: Technical Success and Complicationsmentioning

confidence: 96%

“…In patients with non-dilated ducts, technical success of PTC has been reported between 65% and 90% (11). Success rates of PTBD for biliary leakage are reported to be 40-100% without secondary surgery ( Table 2) (11,(22)(23)(24)(25)(26)(27).…”

Section: Technical Success and Complicationsmentioning

confidence: 99%

Biliary injuries after pancreatic surgery: interventional radiology management

Angileri¹,

Gorga²,

Tortora³

et al. 2019

Gland Surg

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Bile duct injuries are among the most feared complications after pancreatic surgery. Most of these surgical complications are related to iatrogenic injuries and include bile leakage, biliary duct obstruction or stricture and infection. A wide range of Interventional Radiology treatment options are currently available. The options include percutaneous transhepatic cholangiography (PTC), percutaneous transhepatic biliary drainage (PTBD), percutaneous balloon dilatation and stenting, image-guided percutaneous abscess drainage. The purpose of this review is to describe the current evidence in this continuously evolving field.

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“…Two fellowship-trained interventional radiologists (A.S. and J.W., with 4 and 6 years of interventional radiology experience, respectively) independently reviewed the medical re- [5][6][7][8][9][10][11][12][13][14]. Among all patients who were readmitted, there were 47.5% (58 of 122; Table 3) who were admitted between 0 and 7 days and 52.4% (64 of 122) between 8 and 30 days.…”

Section: Assessment Of Cause and Preventability Of Readmissionmentioning

confidence: 99%

“…Just over half of all readmissions related to interventional radiology were deemed preventable. For example, four readmissions were because of interventional radiology care: two patients who did not have more than 75% of their hepatic segments drained, as generally recommended; and two patients with biliary leaks whose drains were capped prematurely, before resolution of the leak as generally recommended (8,12,13). Similarly, patients who presented with leakage after discharge typically had the proximal side holes of their internal-external biliary drainage catheter positioned centrally, resulting in exclusion of segmental ducts.…”

Section: Assessment Of Cause and Preventability Of Readmissionmentioning

confidence: 99%

Causes and Rates of 30-day Readmissions after Percutaneous Transhepatic Biliary Drainage Procedure

et al. 2019

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To investigate rates and causes of 30-day readmission for patients who undergo percutaneous transhepatic biliary drainage (PTBD) procedures. Materials and Methods: In this retrospective study, PTBD procedures performed at a tertiary care institution (June 2008 to May 2013) were reviewed. For each patient, the first 30-day readmission was used to determine cause of readmission. Two interventional radiologists independently categorized causes for readmission as planned or unplanned, and unplanned causes as related to or unrelated to interventional radiology. Interventional radiology-related readmissions were categorized as potentially preventable or unpreventable. Factors associated with higher odds for 30-day readmission were identified with univariable and multivariable analysis. Results: There were 266 procedures in 266 patients (mean age, 67 years; interquartile range, 57-76 years; 53.4% men). The cause of obstruction was malignant in 50.0% of patients (133 of 266). There were 122 of 266 patients (45.9%) readmitted within 30 days. Of these readmissions, 44 of 122 (36.1%) were planned and 78 of 122 (63.9%) were unplanned. A majority of unplanned readmissions (57 of 78; 73%) were related to interventional radiology. Of unplanned interventional radiology-related readmissions, 16% (nine of 57) were related to periprocedural complications and 51% (29 of 57) were considered preventable. At multivariable analysis, Medicaid insurance (odds ratio, 3.68; 95% confidence interval: 1.52, 9.99; P = .009) and bilateral PTBDs (odds ratio, 5.81; 95% confidence interval: 1.79, 18.90; P = .003) were associated with 30-day readmission. Conclusion: Thirty-day readmissions after primary biliary drainage are common and a majority of unplanned readmissions are drainrelated. Nearly half of unplanned interventional radiology-related readmissions are potentially preventable.

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Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Cited by 17 publications

References 11 publications

Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery

Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery

Biliary injuries after pancreatic surgery: interventional radiology management

Causes and Rates of 30-day Readmissions after Percutaneous Transhepatic Biliary Drainage Procedure

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