Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage |
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| Affiliation: | 1. Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands;2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;3. Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands;4. Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands;1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan;2. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA;1. Department of Surgery, Chung-Ang University College of Medicine, Seoul, South Korea;2. Department of Radiology, Chung-Ang University College of Medicine, Seoul, South Korea;1. Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands;2. Erasmus MC Transplant Institute, Department of Surgery, Division of HPB & Transplant Surgery, Rotterdam, the Netherlands;3. Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands;4. Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands;5. Translational Cancer Research Unit (GZA Hospitals and University of Antwerp), Antwerp, Belgium;1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;2. Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore;3. National University Centre for Organ Transplantation, National University Hospital, Singapore |
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| Abstract: | ![]()
BackgroundComplementary 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.MethodsAll patients undergoing PTBD for leakage 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.ResultsFollowing 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).ConclusionAlthough 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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