Imaging findings and available percutaneous techniques for the treatment of bile leaks after hepatobiliary surgery.
Bile leakage
covered stents
embolization
percutaneous transhepatic biliary drainage
postoperative complications
Journal
Annals of gastroenterology
ISSN: 1108-7471
Titre abrégé: Ann Gastroenterol
Pays: Greece
ID NLM: 101121847
Informations de publication
Date de publication:
Historique:
received:
29
04
2020
accepted:
06
07
2020
entrez:
9
11
2020
pubmed:
10
11
2020
medline:
10
11
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 33162745
doi: 10.20524/aog.2020.0532
pii: AnnGastroenterol-33-675
pmc: PMC7599347
doi:
Types de publication
Journal Article
Langues
eng
Pagination
675-679Informations de copyright
Copyright: © Hellenic Society of Gastroenterology.
Déclaration de conflit d'intérêts
Conflict of Interest: None
Références
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
Gland Surg. 2019 Apr;8(2):141-149
pubmed: 31183324
AJR Am J Roentgenol. 2010 Oct;195(4):851-7
pubmed: 20858809
Radiology. 1996 Dec;201(3):595-603
pubmed: 8939202
Gland Surg. 2019 Apr;8(2):174-183
pubmed: 31183327
Korean J Intern Med. 2017 Jan;32(1):79-84
pubmed: 27389530
J Vasc Interv Radiol. 2017 Oct;28(10):1432-1437.e3
pubmed: 28757285
Cardiovasc Intervent Radiol. 2018 Oct;41(10):1566-1572
pubmed: 29872897
Indian J Surg. 2017 Feb;79(1):24-28
pubmed: 28331262
Am J Surg. 2008 Mar;195(3):386-90; discussion 390
pubmed: 18308043
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Visc Med. 2017 Jun;33(3):192-196
pubmed: 28785566
Liver Transpl. 2008 May;14(5):611-5
pubmed: 18433033
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
JOP. 2014 Jul 28;15(4):378-82
pubmed: 25076347
Dig Surg. 2012;29(1):48-53
pubmed: 22441620
Diagn Interv Radiol. 2007 Jun;13(2):101-4
pubmed: 17562517
Eur Radiol. 2010 May;20(5):1061-8
pubmed: 19890645
J Gastrointest Surg. 2003 Feb;7(2):209-19
pubmed: 12600445
HPB (Oxford). 2016 Apr;18(4):367-74
pubmed: 27037207
Hepatobiliary Pancreat Dis Int. 2016 Feb;15(1):81-6
pubmed: 26818547
Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):380-8
pubmed: 16502179