Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage
Henry, Anne Claire; Smits, F. Jasmijn; van Lienden, Krijn; van den Heuvel, Daniel A.F.; Hofman, Lieke; Busch, Olivier R.; van Delden, Otto M.; Zijlstra, IJsbrand A.; Schreuder, Sanne M.; Lamers, Armand B.; van Leersum, Marc; van Strijen, Marco J.L.; Vos, Jan A.; Te Riele, Wouter W.; Molenaar, I. Quintus; Besselink, Marc G.; van Santvoort, Hjalmar C.
(2022) HPB, volume 24, issue 4, pp. 489 - 497
(Article)
Abstract
Background: Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication. Methods: All patients undergoing PTBD for leakage
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after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014–2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage. Results: Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21–60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2). Conclusion: Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.
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Keywords: Hepatology, Gastroenterology
ISSN: 1365-182X
Publisher: John Wiley and Sons Inc.
Note: Funding Information: ACH, FJS, KVL, WTR, IQM and HCvS contributed to the conception and design of the work. All authors contributed to patient recruitment and data acquisition. ACH performed statistical analysis and data analysis. ACH drafted the manuscript. All authors had substantial contribution to interpretation of the data, added important intellectual content to the work and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work and agree that no questions remain related to the accuracy or integrity of any part of the work. Publisher Copyright: © 2021 International Hepato-Pancreato-Biliary Association Inc.
(Peer reviewed)