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Chen J, Wang Z, Zhang L, Chen X, Liu Y, Chen H, Tong X, Dong Y. Application of percutaneous biliary drainage in the treatment of post-operative bile leakage after liver rupture: A case report. J Minim Access Surg 2025; 21:200-204. [PMID: 38214313 PMCID: PMC12054958 DOI: 10.4103/jmas.jmas_245_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Post-operative bile leakage (POBL) is a serious complication following hepatobiliary surgery, with potentially life-threatening consequences if left untreated. This article presents a successful case of POBL management without surgical intervention. A 31-year-old male, diagnosed with bile leakage before hospitalisation, underwent percutaneous biliary drainage (PTBD) to address bilomas. Follow-up after 3 months indicated biloma atrophy and POBL healing but revealed bile duct stenosis. The patient received a larger biliary drainage tube, and after 1 month, the biloma and tube were removed. A 1-year follow-up confirmed the patient's excellent health. This case underscores the safety and efficacy of PTBD for managing POBL, offering a non-invasive alternative for patients with this complication. PTBD presents a viable treatment option for POBL cases, minimising the need for surgical interventions and their associated risks.
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Affiliation(s)
- Jinlong Chen
- Department of Interventional Treatment, Qinhuangdao Haigang Hospital, Qinhuangdao, Hebei, China
| | - Zhikuan Wang
- Department of Interventional Treatment, Qinhuangdao Haigang Hospital, Qinhuangdao, Hebei, China
| | - Lixin Zhang
- Department of Cardiovascular, Qinhuangdao Haigang Hospital, Qinhuangdao, Hebei, China
| | - Xi Chen
- Department of Stomatology, Graduate College, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yuanyuan Liu
- Department of Cardiovascular, Qinhuangdao Public Security Hospital, Qinhuangdao, Hebei, China
| | - Hong Chen
- Department of Radiology, Qinhuangdao Haigang Hospital, Qinhuangdao, Hebei, China
| | - Xiaoqiang Tong
- Department of Interventional Treatment, Peking University First Hospital, Beijing, China
| | - Yanchao Dong
- Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
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Kokas B, Ulmann L, Rozman P, Farkas N, Szijártó A, Szücs Á. Postoperative bile leak after hepato-pancreato-biliary surgery in malignant biliary obstruction: rates, treatments, and outcomes in a high-volume tertiary referral center. BMC Surg 2024; 24:410. [PMID: 39710665 DOI: 10.1186/s12893-024-02721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/10/2024] [Indexed: 12/24/2024] Open
Abstract
BACKGROUND Biliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians. OBJECTIVE This study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center. METHODS A retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021. Data from patients with malignant biliary obstruction was analyzed collectively and in two homogenous cohorts: distal malignant (DM) group with distal biliary obstruction undergoing pancreatic head resection, proximal malignant (PM) group with perihilar biliary obstruction undergoing perihilar biliary resection without liver resection. RESULTS 724 patients were found. After exclusions, 410 remained in the DM and 41 in the PM group. In the DM group the leak rate was 5.6% (23/410). Mortality was 3.9%, in patients with anastomotic failure 26% (6/23) vs no failure 2.6% (10/387) (p‹0.0001). Leak rate in the ASA III and ASA I-II patients were 52.2% (12/23) vs 48.8% (11/23), (p = 0.597). Leak rates were higher in the PM group 14,6% (6/41), mortality was 4.9% (2/41). All leaks in the PM group occurred in ASA III patients (6/6). No statistically significant associations were found between leak rates and factors such as patient age, preoperative serum bilirubin levels, preoperative or intraoperative biliary drainage, cholangitis, blood transfusion, postoperative pancreatic fistula, or bile duct dilation in either group. Bile leaks (n = 29) were treated conservatively (n = 9) with percutaneous transhepatic drainage (n = 3) or reoperation with (n = 16) or without (n = 10) external biliary drainage. Clinical success rates were slightly higher after reoperation with external drainage. CONCLUSION This study identified perihilar resection as a risk factor for biliary leakage and trends indicating higher leak rates among patients with advanced comorbidities (ASA III), elevated preoperative bilirubin levels, non-dilated bile ducts, cholangitis or postoperative pancreatic fistula but these associations did not reach statistical significance, likely due to the limited sample size. In the management of anastomotic leakage, conservative and minimally invasive methods are effective; however, most cases required relaparotomy combined with external biliary drainage.
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Affiliation(s)
- Bálint Kokas
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Lőrinc Ulmann
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Petra Rozman
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, University of Pécs, Pécs, Hungary
| | - Attila Szijártó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Ákos Szücs
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.
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Zheng Q, Ou D, Xie F, Chen L. Contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage is a safe and effective procedure for patients with malignant biliary obstruction and stage 3 chronic kidney disease. Eur J Radiol 2024; 181:111761. [PMID: 39342886 DOI: 10.1016/j.ejrad.2024.111761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES This study aimed to validate the efficacy and safety of contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage (CEUS-PTCD) as a biliary drainage procedure in patients with malignant biliary obstruction and stage 3 chronic kidney disease (CKD3). MATERIALS AND METHODS Between January 2019 and December 2023, 634 patients who underwent CEUS-PTCD were retrospectively enrolled in this study. During the procedure, imaging parameters such as the maximum diameter of the dilated bile duct, presence of ascites, detailed findings from CEUS, and clinical outcomes were meticulously recorded. Laboratory results, including serum bilirubin levels, liver function tests, and estimated glomerular filtration rate (eGFR), were evaluated in one day before and three days after procedure. The aforementioned parameters were compared using the paired-sample t test and the Wilcoxon test. RESULTS A total of 66 (10.41 %) patients with malignant biliary obstruction and CKD3 were included in the final analysis (median age: 66, range: 30-89 years, 46 males and 20 females). Procedure records indicated that 23 patients (34.8 %) had a maximum biliary duct dilation diameter of ≤ 4 mm, while 5 patients (7.6 %) exhibited mild ascites. Additionally, 24 patients (36.4 %) had ultrasound contrast agent entry into both the biliary duct and bloodstream. All patients successfully achieved external bile drainage following CEUS-PTCD, with no significant complications observed during or after the intervention. Post-procedure, there was a statistically significant reduction in all previously elevated serum bilirubin and liver enzyme levels (P-values were less than 0.05). Furthermore, no statistically significant alterations in eGFR were observed prior to or following CEUS-PTCD across all patients (P = 0.295), including comparisons between groups with and without the ultrasound contrast agent into the bloodstream (P = 0.254). CONCLUSION CEUS-PTCD is a safe and effective biliary drainage procedure for patients with malignant biliary obstruction and CKD3.
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Affiliation(s)
- Qiuqing Zheng
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022 Hangzhou, Zhejiang, China.
| | - Di Ou
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022 Hangzhou, Zhejiang, China.
| | - Fajun Xie
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022 Hangzhou, Zhejiang, China; Department of Medical Oncology, Taizhou Cancer Hospital, 317502 Taizhou, Zhejiang, China.
| | - Liyu Chen
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, 310022 Hangzhou, Zhejiang, China.
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Neitzel E, Stearns J, Guido J, Porter K, Whetten J, Lammers L, vanSonnenberg E. Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures. Abdom Radiol (NY) 2024; 49:4074-4091. [PMID: 38849536 DOI: 10.1007/s00261-024-04381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks. METHODS A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article. RESULTS 214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG. CONCLUSION Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA.
| | - Jack Stearns
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jessica Guido
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Kaiden Porter
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Jed Whetten
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Luke Lammers
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, 475 N 5th St, HSEB C523, Phoenix, AZ, 85004, USA
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de Jong DM, Mulder YL, van Dam JL, Groot Koerkamp B, Bruno MJ, de Jonge PJF. Clinical outcome of endoscopic treatment of symptomatic Hepaticojejunal anastomotic strictures after pancreatoduodenectomy. HPB (Oxford) 2023; 25:1040-1046. [PMID: 37290989 DOI: 10.1016/j.hpb.2023.05.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD. METHODS Patients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation. RESULTS A total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2-NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis. DISCUSSION Endoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.
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Affiliation(s)
- David M de Jong
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Yoklan L Mulder
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - J L van Dam
- Department of Surgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
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Symeonidis D, Tepetes K, Tzovaras G, Samara AA, Zacharoulis D. BILE: A Literature Review Based Novel Clinical Classification and Treatment Algorithm of Iatrogenic Bile Duct Injuries. J Clin Med 2023; 12:3786. [PMID: 37297981 PMCID: PMC10253433 DOI: 10.3390/jcm12113786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSES The management of patients with iatrogenic bile duct injuries (IBDI) is a challenging field, often with dismal medico legal projections. Attempts to classify IBDI have been made repeatedly and the final results were either analytical and extensive but not useful in everyday clinical practice systems, or simple and user friendly but with limited clinical correspondence approaches. The purpose of the present review is to propose a novel, clinical classification system of IBDI by reviewing the relevant literature. METHODS A systematic literature review was conducted by performing bibliographic searches in the available electronic databases, including PubMed, Scopus, and the Cochrane Library. RESULTS Based on the literature results, we propose a five (5) stage (A, B, C, D and E) classification system for IBDI (BILE Classification). Each stage is correlated with the recommended and most appropriate treatment. Although the proposed classification scheme is clinically oriented, the anatomical correspondence of each IBDI stage has been incorporated as well, using the Strasberg classification. CONCLUSIONS BILE classification represents a novel, simple, and dynamic in nature classification system of IBDI. The proposed classification focuses on the clinical consequences of IBDI and provides an action map that can appropriately guide the treatment plan.
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Affiliation(s)
| | | | | | - Athina A. Samara
- Department of Surgery, University Hospital of Larisa, Mezourlo, 41221 Larisa, Greece
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7
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Handke NA, Ollig A, Attenberger UI, Luetkens JA, Faron A, Pieper CC, Schmeel FC, Kupczyk PA, Meyer C, Kuetting D. Percutaneous transhepatic biliary drainage: a retrospective single-center study of 372 patients. Acta Radiol 2022; 64:1322-1330. [PMID: 36128748 DOI: 10.1177/02841851221127809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complication rates in percutaneous transhepatic biliary drainage (PTBD) are non-uniform and vary considerably. In addition, the impact of peri-procedural risk factors is under-investigated. PURPOSE To compare success and complication rates of PTBD in patients with and without accompanying technical risk factors. MATERIAL AND METHODS A single-center retrospective study was conducted from January 2004 to December 2016. Patients receiving PTBD due to biliary obstruction or biliary leakage were included. Technical risk factors (non-distended bile ducts, ascites, obesity, anasarca, non-compliance) were assessed. Complications were classified according to the Society of Interventional Radiology. RESULTS In total, 372 patients were included (57.3% men, 42.7% women; mean age = 66 years). Overall, 466 PTBDs were performed. Of the patients, 70.1% presented with malignancy and biliary obstruction; 26.8% had benign biliary obstruction; 3.1% had biliary leakage. Technical risk factors were reported in 57 (15.3%) patients. Overall technical success of initial PTBD was 98.7%, primary technical success was 97.9%. In patients with non-dilatated bile ducts, primary technical success was 68.2%. Overall complication rate was 15.0% (8.1% major complications, 6.9% minor complications). Neither major nor minor complications were more frequent in patients with technical risk factors (P > 0.05). In left-sided PTBD, hemorrhage was more frequent (P = 0.015). Patients with malignancy were significantly more affected by drainage-related complications (P = 0.004; odds ratio = 2.03). The mortality rate was 0.5% (n = 2). CONCLUSION PTBD is a safe and effective method for the treatment of biliary obstruction and biliary leaks. Complication rates are low, even in procedures with risk factors.
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Affiliation(s)
- Nikolaus A Handke
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Annika Ollig
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Julian A Luetkens
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Anton Faron
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | | | - Patrick A Kupczyk
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Carsten Meyer
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
| | - Daniel Kuetting
- Department of Radiology, 9374University Hospital Bonn, Bonn, Germany
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8
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Iatrogenic Complex Hilar Biliary Strictures: Management Strategies and Long-term Outcome. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Henry AC, Smits FJ, van Lienden K, van den Heuvel DAF, Hofman L, Busch OR, van Delden OM, Zijlstra IJA, Schreuder SM, Lamers AB, van Leersum M, van Strijen MJL, Vos JA, Te Riele WW, Molenaar IQ, Besselink MG, van Santvoort HC. Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage. HPB (Oxford) 2022; 24:489-497. [PMID: 34556407 DOI: 10.1016/j.hpb.2021.08.941] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/02/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022]
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 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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Affiliation(s)
- Anne Claire Henry
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - F Jasmijn Smits
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Krijn van Lienden
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Daniel A F van den Heuvel
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Lieke Hofman
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Otto M van Delden
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - IJsbrand A Zijlstra
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Sanne M Schreuder
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Armand B Lamers
- Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc van Leersum
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Marco J L van Strijen
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Wouter W Te Riele
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - I Quintus Molenaar
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands.
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10
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Su WL, Yu FJ, Huang JW, Shih MC, Hsu WH, Shih HY, Huang YL, Chen LA, Wu PH, Wu CJ, Chen CY, Kuo KK, Lee KT, Chang WT. The experience of use of percutaneous transhepatic biliary drainages for early biliary complications after liver transplantation. Kaohsiung J Med Sci 2022; 38:486-493. [PMID: 35199937 DOI: 10.1002/kjm2.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n = 5) or not (group B, n = 4). In group A, the technical and long-term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure-related complications were encountered. In group B, the technical and long-term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re-transplantation. The other two patients died of sepsis due to PTBD-related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.
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Affiliation(s)
- Wen-Lung Su
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jian-Wei Huang
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Ming-Chen Shih
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ling Huang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ling-An Chen
- Department of Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Jen Wu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chiao-Yun Chen
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kung-Kai Kuo
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - King-Teh Lee
- Department of Surgery, Park One International Hospital, Kaohsiung, Taiwan
| | - Wen-Tsan Chang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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11
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Filipović AN, Mašulović D, Zakošek M, Filipović T, Galun D. Total Fluoroscopy Time Reduction During Ultrasound- and Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage Procedure: Importance of Adjusting the Puncture Angle. Med Sci Monit 2021; 27:e933889. [PMID: 34802031 PMCID: PMC8614062 DOI: 10.12659/msm.933889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this observational cohort study was to assess patient and operator-dependent factors which could have an impact on total fluoroscopy time during ultrasound and fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD). MATERIAL AND METHODS Between October 2016 and November 2020, 127 patients with malignant biliary obstruction underwent ultrasound- and fluoroscopy-guided PTBD with the right-sided intercostal approach. The initial bile duct puncture was ultrasound-guided in all patients, and the puncture angle was measured by ultrasound. Any subsequent steps of the procedure were performed under continuous fluoroscopy (15 fps). The patients were divided in 2 groups based on the puncture angle: ≤30° (group I) and >30° (group II). In a retrospective analysis, both groups were compared for inter- and intragroup variability, technical success, total fluoroscopy time, and complications. RESULTS In group II, the recorded total fluoroscopy time (232.20±140.94 s) was significantly longer than that in group I (83.44±52.61 s) (P<0.001). In both groups, total fluoroscopy time was significantly longer in cases with a lesser degree of bile duct dilatation, intrahepatic bile duct tortuosity, presence of liver metastases, and multiple intrahepatic bile duct strictures. CONCLUSIONS The initial bile duct puncture angle was identified as an operator-dependent factor with the possible impact on total fluoroscopy time. The puncture angle of less than 30° was positively correlated with overall procedure efficacy and total fluoroscopy time reduction.
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Affiliation(s)
- Aleksandar N. Filipović
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Mašulović
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miloš Zakošek
- Center for Radiology and Magnetic Resonance Imaging (MRI), University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tamara Filipović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Rehabilitation, Belgrade, Serbia
| | - Danijel Galun
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- HPB Unit, Clinic for Digestive Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
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12
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Mosconi C, Calandri M, Mirarchi M, Vara G, Breatta AD, Cappelli A, Brandi N, Paccapelo A, De Benedittis C, Ricci C, Sassone M, Ravaioli M, Fronda M, Cucchetti A, Petrella E, Casadei R, Cescon M, Romagnoli R, Ercolani G, Giampalma E, Righi D, Fonio P, Golfieri R. Percutaneous management of postoperative Bile leak after hepato-pancreato-biliary surgery: a multi-center experience. HPB (Oxford) 2021; 23:1518-1524. [PMID: 33832832 DOI: 10.1016/j.hpb.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile leak (BL) after hepato-pancreato-biliary (HPB) surgery is associated with significant morbidity and mortality. Aim of this study was to evaluate effectiveness and safety of percutaneous transhepatic approach (PTA) to drainage BL after HPB surgery. METHODS Between 2006 and 2018, consecutive patients who were referred to interventional radiology units of three tertiary referral hospitals were retrospectively identified. Technical success and clinical success were analyzed and evaluated according to surgery type, BL-site and grade, catheter size and biochemical variables. Complications of PTA were reported. RESULTS One-hundred-eighty-five patients underwent PTA for BL. Technical success was 100%. Clinical success was 78% with a median (range) resolution time of 21 (5-221) days. Increased clinical success was associated with patients who underwent hepaticresection (86%,p = 0,168) or cholecystectomy (86%,p = 0,112) while low success rate was associated to liver-transplantation (56%,p < 0,001). BL-site,grade, catheter size and AST/ALT levels were not associated with clinical success. ALT/AST high levels were correlated to short time resolution (17 vs 25 days, p = 0,037 and 16 vs 25 day, p = 0,011, respectively) Complications of PTA were documented in 21 (11%) patients. CONCLUSION This study based on a large cohort of patients demonstrated that PTA is a valid and safe approach in BL treatment after HPB surgery.
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Affiliation(s)
- Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Marco Calandri
- Radiology Unit, A.O.U. San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043, Orbassano, Torino, Italy; Department of Oncology, University of Torino, Via Verdi 8, 10124, Torino, Italy
| | - Mariateresa Mirarchi
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy.
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Andrea D Breatta
- Radiology Unit, A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Caterina De Benedittis
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Claudio Ricci
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mirian Sassone
- Radiology Unit, A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Matteo Ravaioli
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Fronda
- Radiology Unit, A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Alessandro Cucchetti
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Enrico Petrella
- Radiology Unit, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521, Cesena, Italy
| | - Riccardo Casadei
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Cescon
- General Surgery and Transplantation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Renato Romagnoli
- Liver Transplant Unit "E.Curtoni", A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy; Department of Surgical Sciences, University of Torino, Via Verdi 8, 10124, Torino, Italy
| | - Giorgio Ercolani
- General and Oncology Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Emanuela Giampalma
- Radiology Unit, Bufalini Hospital, Viale Giovanni Ghirotti, 286, 47521, Cesena, Italy
| | - Dorico Righi
- Radiology Unit, A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Paolo Fonio
- Radiology Unit, A.O.U. Città Della Salute e Della Scienza, Corso Bramante, 88, 10126, Torino, Italy; Department of Surgical Sciences, University of Torino, Via Verdi 8, 10124, Torino, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
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13
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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14
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Karatoprak S, Kutlu R, Yılmaz S. Role of percutaneous radiological treatment in biliary complications associated with adult left lobe living donor liver transplantation: a single-center experience. ACTA ACUST UNITED AC 2021; 27:546-552. [PMID: 33599206 DOI: 10.5152/dir.2021.20523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Biliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications after LDLT were made with the right lobe. The aim of this study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment. METHODS A total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzed regarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/ percutaneous transhepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed. RESULTS A total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopic and/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bile leakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosis stricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of 4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bile duct cannulation could not be obtained because of duodenal diverticulum (n=1). Diagnostic PTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedure and two were referred directly without ERCP. Anastomosis stricture was found in 7 patients and anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture, balloon dilatation was applied and then biliary drainage was performed. In 3 patients who had leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a covered metallic stent passing through the leakage region was placed in one patient. CONCLUSION Generally, ERCP is the first preferred method in biliary complications of LDLT; however, in cases where a response cannot be obtained by endoscopic treatment or require complex and/or aggressive treatment, percutaneous radiological treatment should be the treatment of choice before surgery in left lobe LDLT.
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Affiliation(s)
- Sinan Karatoprak
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yılmaz
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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15
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de’Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de’Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, Sommacale D. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16:30. [PMID: 34112197 PMCID: PMC8190978 DOI: 10.1186/s13017-021-00369-w] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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Affiliation(s)
- Nicola de’Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital “F. Miulli”, Strada Prov. 127 Acquaviva – Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fausto Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Oreste M. Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, Michigan USA
| | - Belinda De Simone
- Service de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en Laye, Saint Germain en Laye, France
| | - Salomone Di Saverio
- Department of Surgery, Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Raffaele Brustia
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
- Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Maria Conticchio
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Nassiba Beghdadi
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Shosse Enthusiastov, 86, 111123 Moscow, Russia
| | | | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Giuliana Amaddeo
- Service d’Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- General Surgery, San Matteo University Hospital, Pavia, Italy
| | | | - Enrico Andolfi
- Department of Surgery, Division of General Surgery, San Donato Hospital, 52100 Arezzo, Italy
| | - Mohammad Azfar
- Department of Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital “F. Miulli”, Strada Prov. 127 Acquaviva – Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
| | - Walter L. Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, California USA
| | - Francesco Brunetti
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | | | - Daniel Casanova
- Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Valerio Celentano
- Colorectal Unit, Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan Bicocca, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center – CECORC and Loma Linda University School of Medicine, Loma Linda, USA
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
| | - Andrea De Palma
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Philip R. de Reuver
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlos Domingo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Alessandro Ferrero
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano “Umberto I”, Turin, Italy
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Gurrado
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Ewen Harrison
- Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Stefan Hofmeyr
- Division of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, University of Stellenbosch Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | - Roberta Iadarola
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Jeffry L. Kashuk
- Department of Surgery, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Andrew W. Kirkpatrick
- Department of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical Center, Calgari, Alberta Canada
| | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Filippo Landi
- Department of HPB and Transplant Surgery, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Serena Langella
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano “Umberto I”, Turin, Italy
| | - Real Lapointe
- Department of HBP Surgery and Liver Transplantation, Department of Surgery, Centre Hospitalier de l’Université de Montreal, Montreal, QC Canada
| | - Bertrand Le Roy
- Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Alain Luciani
- Unit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fernando Machado
- Department of Emergency Surgery, Hospital de Clínicas, School of Medicine UDELAR, Montevideo, Uruguay
| | - Umberto Maggi
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi Japan
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Universidad del Valle Cali, Cali, Colombia
| | - Franca Patrizi
- Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy
| | - Manuel Planells
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Andrew B. Peitzman
- Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Juan Pekolj
- General Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fabiano Perdigao
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Bruno M. Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Patrick Pessaux
- Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, Strasbourg, France
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Juan Carlos Puyana
- Trauma & Acute Care Surgery – Global Health, University of Pittsburgh, Pittsburgh, USA
| | - Sandro Rizoli
- Trauma and Acute Care Service, St Michael’s Hospital, Toronto, ON Canada
| | - Luca Portigliotti
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Behnam Sanei
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Olivier Scatton
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Mario Serradilla-Martin
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-À-Pitre, Les Avymes, Guadeloupe France
| | - Mohammed Lamine Sissoko
- Service de Chirurgie, Hôpital National Blaise Compaoré de Ouagadougou, Ouagadougou, Burkina Faso
| | - Iradj Sobhani
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Richard P. ten Broek
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Mario Testini
- Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Roberto Valinas
- Department of Surgery “F”, Faculty of Medicine, Clinic Hospital “Dr. Manuel Quintela”, Montevideo, Uruguay
| | | | - Giulio Cesare Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Luigi Zorcolo
- Department of Surgery, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation “Policlinico Universitario A. Gemelli”, IRCCS, Rome, Italy
| | - Paschalis Gavriilidis
- Division of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, Hammersmith Hospital, London, UK
| | - David Fuks
- Institut Mutualiste Montsouris, Paris, France
| | - Daniele Sommacale
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
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16
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Hafezi-Nejad N, Bailey CR, Areda MA, Lafaro KJ, Liddell RP, Holly BP, Weiss CR. Characteristics and Outcomes of Percutaneous Biliary Interventions in the United States. J Am Coll Radiol 2021; 18:1059-1068. [PMID: 33848506 DOI: 10.1016/j.jacr.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To explore baseline characteristics, comorbidities, and clinical diagnoses in the prediction of outcomes for inpatient percutaneous biliary interventions in the United States. METHODS Hospitalizations for percutaneous transhepatic cholangiography and percutaneous biliary drainage were studied using the National Inpatient Sample 2012 to 2015. Associations between baseline characteristics, comorbidities, clinical diagnoses, and outcomes were analyzed using multivariable regression modeling. Regional variations were studied in an exploratory analysis. RESULTS Hospitalizations for percutaneous biliary interventions had average inpatient mortality of 3.8% ± 0.8% and length of stay of 7.6 ± 0.3 days. Hypertension was the most common comorbidity (50.5% ± 0.8%), and paralysis was associated with the highest inpatient mortality (19.1% ± 5.7%) and length of stay (11.4 ± 1.3 days). Compared with nonmalignant biliary-pancreatic disorders, sepsis was associated with the highest inpatient mortality (6.5% ± 1.1%; adjusted odds ratio [aOR]: 5.2 [3.9-7.0]) and length of stay (9.0 ± 3.0 days; aOR: 2.2 [1.9-2.5]), followed by underlying malignancy (mortality of 5.5% ± 0.6%; aOR: 2.3 [1.7-3.0]; length of stay of 8.3 ± 0.2 days; aOR: 1.6 [1.4-1.8]). The observed associations were independent of baseline characteristics and comorbidities. With regard to regional variations, the Middle Atlantic states had the lengthiest hospital stays (38.8% ± 2.0% >8 days) and the East South Central states had the highest inpatient mortality (6.6% ± 1.6%) while having the highest frequency of malignancy (37.9% ± 3.7%) and the lowest frequency of postoperative cases (15.2% ± 2.4%). CONCLUSION In addition to baseline characteristics and comorbidities, sepsis and malignancy were determinants of higher mortality and increased length of stay in hospitalizations for percutaneous biliary interventions. We observed significant regional variations in clinical diagnoses and outcomes across the United States.
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Affiliation(s)
- Nima Hafezi-Nejad
- Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Christopher R Bailey
- Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Moustafa Abou Areda
- Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly J Lafaro
- Assistant Professor of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert P Liddell
- Assistant Professor of Radiology and Radiological Science, Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Brian P Holly
- Assistant Professor of Radiology and Radiological Science; Program Director, Vascular and Interventional Radiology Fellowship, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Clifford R Weiss
- Associate Professor of Radiology, Surgery and Biomedical Engineering; Medical Director, Johns Hopkins Center for Bioengineering, Innovation, and Design; Director, Johns Hopkins Interventional Radiology Research; Director, Johns Hopkins HHT Center of Excellence; Director, Johns Hopkins Vascular Anomalies; Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
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17
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Ko GY, Sung KB, Gwon DI. The Application of Interventional Radiology in Living-Donor Liver Transplantation. Korean J Radiol 2021; 22:1110-1123. [PMID: 33739630 PMCID: PMC8236365 DOI: 10.3348/kjr.2020.0718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 11/14/2020] [Indexed: 01/10/2023] Open
Abstract
Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.
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Affiliation(s)
- Gi Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kyu Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Devane AM, Annam A, Brody L, Gunn AJ, Himes EA, Patel S, Tam AL, Dariushnia SR. Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions. J Vasc Interv Radiol 2020; 31:1849-1856. [PMID: 33011014 DOI: 10.1016/j.jvir.2020.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina.
| | - Aparna Annam
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado; Interventional Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Lynn Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Sean R Dariushnia
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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19
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Yang Y, Liu RB, Liu Y, Jiang HJ. Incidence and risk factors of pancreatitis in obstructive jaundice patients after percutaneous placement of self-expandable metallic stents. Hepatobiliary Pancreat Dis Int 2020; 19:473-477. [PMID: 32291180 DOI: 10.1016/j.hbpd.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/12/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Percutaneous transhepatic biliary drainage is an alternative treatment for patients with malignant distal biliary obstruction. The aim of this study was to investigate the occurrence of pancreatitis in patients who had undergone percutaneous placement of a biliary stent and to assess the risk factors for pancreatitis and the treatment outcomes. METHODS From January 2010 to October 2016, 980 patients in our hospital who underwent percutaneous placements of self-expandable metallic stents for obstructive jaundice were retrospectively analyzed. The incidence of pancreatitis and risk factors were assessed by univariate and multivariate logistic regression analysis. Therapeutics, such as somatostatin, which were also adminstrated to release the symptom and promote the restoration of normal function of pancreas, were also analyzed. RESULTS Pancreatitis occurred in 45 (4.6%) patients. One patient died from severe acute pancreatitis. Multivariate logistic regression analysis showed that common bile duct stent placement was the only independent risk factor that related to pancreatitis (odds ratio = 2.096, 95% CI: 1.248-5.379; P = 0.002). By using somatostatin, the concentrations of serum amylase and lipase were decreased in 44 patients with pancreatitis. No major complications were found during the treatment. CONCLUSIONS Pancreatitis is a relatively low complication of percutaneous placement of biliary stents. The common bile duct stent placement is the only independent risk factor that related to pancreatitis. In this case, the percutaneous transhepatic biliary drainage is a preferred method for treatment. Furthermore, somatostatin is a secure and efficacious method to release the symptom and promote the restoration of pancreatic function.
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Affiliation(s)
- Yi Yang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Rui-Bao Liu
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Yan Liu
- Department of Interventional Radiology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Hui-Jie Jiang
- Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
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20
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Navez J, Gigot JF, Deprez PH, Goffette P, Annet L, Zech F, Hubert C. Long-term results of secondary biliary repair for cholecystectomy-related bile duct injury: results of a tertiary referral center. Acta Chir Belg 2020; 120:92-101. [PMID: 30727824 DOI: 10.1080/00015458.2019.1570741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Management of bile duct injury (BDI) after cholecystectomy is challenging. The authors analyzed their center's 49-year experience.Methods: From 1968 to 2016, 120 consecutive patients were managed in a tertiary HBP center, 105 referred from other centers (Group A), 15 from our center (Group B). Surgical strategies and long-term outcomes were retrospectively reviewed.Results: Primary cholecystectomy approach was open in 35% and laparoscopic in 65%. In Group A, intraoperative BDI diagnosis was made in 25/105 patients, including 13 via intraoperative cholangiography (IOC) which was used in 21% of cases. Median time from BDI to referral was 148 days (range 0-10,758), and 3 patients had BDI-related secondary cirrhosis. Ninety-four patients underwent secondary surgical repair, mostly a complex biliary procedure (97%). Postoperative overall and severe morbidity rates were 26% and 6%, respectively. One patient with biliary cirrhosis at referral died postoperatively from hepatic failure. Nine patients (9.6%) developed a secondary biliary stricture after a median of 54 months from repair (6-228 months). In Group B, IOC was performed in 14/15 in whom BDI were intraoperatively detected and immediately repaired. There were 13 minor and 2 major BDIs, all repaired by uncomplex procedures with uneventful postoperative course. One patient had a secondary biliary stricture after 5 months, successfully treated by temporary endoprosthesis.Conclusion: Late follow-up after primary or secondary repair of BDI is recommended to detect recurrent biliary stricture. Bile duct injuries may occur in a tertiary center, but are intraoperatively detected with routine IOC and immediately repaired resulting in satisfactory outcome.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Jean-François Gigot
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Goffette
- Department of Radiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurence Annet
- Department of Radiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Francis Zech
- Institute of Experimental and Clinical Research, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Catherine Hubert
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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21
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Ledoux G, Amroun K, Rhaiem R, Cagniet A, Aghaei A, Bouche O, Hoeffel C, Sommacale D, Piardi T, Kianmanesh R. Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor. Surg Endosc 2020; 35:845-853. [PMID: 32076859 DOI: 10.1007/s00464-020-07456-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection. METHODS Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a. RESULTS Mortality was nil and morbidity rate 15.4% including Dindo-Clavien > II grade 3%. The median follow-up was 24 months [0.77-75]. Per lesion LR rate after TA was 18% (n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA. CONCLUSIONS Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.
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Affiliation(s)
- Geoffrey Ledoux
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Koceila Amroun
- University of Reims Champagne Ardenne, Reims, France.,Department of Surgery, Jean Godinot Cancer Institute, Reims, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France. .,Reims Medical Faculty, Reims, France. .,University of Reims Champagne Ardenne, Reims, France.
| | - Audrey Cagniet
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Arman Aghaei
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Olivier Bouche
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Deprtement of Oncology, Robert Debré University- Hospital, Reims, France
| | - Christine Hoeffel
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Departement of Radiology, Robert Debré University- Hospital, Reims, France
| | - Daniele Sommacale
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
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22
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Petrillo M, Ierardi AM, Tofanelli L, Maresca D, Angileri A, Patella F, Carrafiello G. Gd-EOB-DTP-enhanced MRC in the preoperative percutaneous management of intra and extrahepatic biliary leakages: does it matter? Gland Surg 2019; 8:174-183. [PMID: 31183327 DOI: 10.21037/gs.2019.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative bile leakage is a common complication of abdominal surgical procedures and a precise localization of is important to choose the best management. Many techniques are available to correctly identify bile leaks, including ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI), being the latter the best to clearly depict "active" bile leakages. This paper presents the state of the art algorithm in the detection of biliary leakages in order to plan a percutaneous biliary drainage focusing on widely available and safe contrast agent, the Gb-EOB-DPA. We consider its pharmacokinetic properties and impact in biliary imaging explain current debates to optimize image quality. We report common sites of leakage after surgery with special considerations in cirrhotic liver to show what interventional radiologists should look to easily detect bile leaks.
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Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Tofanelli
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Duilia Maresca
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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23
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Houghton E. Complex percutaneous biliary procedures: Review and contributions of a high volume team. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii180036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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24
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Andrea P, Antonio B, Daniela BZ, Luigi P, Fabio C, Mattia S, Giulia F, Francesco G, Raffaella N. Combined surgical and interventional radiological treatment for biliary leakage following iatrogenic biliary obstruction. Radiol Case Rep 2018; 13:772-777. [PMID: 29887931 PMCID: PMC5991901 DOI: 10.1016/j.radcr.2018.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022] Open
Abstract
Biliary leakage is a challenging complication when managing the bile duct strictures. The etiology of benign strictures of the biliary tree may have different etiologies but iatrogenic is the most common, with relevant increase after introduction of laparoscopic procedures. Interventional radiologist plays a key role, both in diagnosis and treatment of biliary strictures and leakage. We report on a case of a 39-year-old woman affected by abdominal pain and jaundice after laparoscopic cholecystectomy; jaundice was caused by surgical clipping of the common bile duct. The combined management by surgeon and interventional radiologist, consisting of removal of surgical clip and percutaneous management of biliary leakage, successfully resolved the leakage with clinical success.
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25
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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26
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Cesaretti M, Dioguardi Burgio M, Zarzavadjian Le Bian A. Abdominal emergencies after liver transplantation: Presentation and surgical management. Clin Transplant 2017; 31. [PMID: 28871618 DOI: 10.1111/ctr.13102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Manuela Cesaretti
- HPB surgery and Liver Transplantation department; Hôpital Beaujon; Clichy; Assistance Publique - Hôpitaux de Paris; Paris Diderot University; Paris France
- Istituto Italiano di Tecnologia; Genova Italy
| | - Marco Dioguardi Burgio
- Diagnostic and Interventional Radiology; Hôpital Beaujon; Clichy; Assistance Publique - Hôpitaux de Paris; Paris Diderot University; Paris France
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Digestive; Centre Hospitalier Simone Veil; Eaubonne France
- Laboratoire d'Ethique Médicale et de Médecine Légale; Université Paris Descartes; Paris France
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27
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Management of an Accessory Bile Duct Leak Following Pancreaticoduodenectomy: A Novel Approach Utilizing a Percutaneous and Endoscopic Rendezvous. ACG Case Rep J 2017; 4:e2. [PMID: 28138446 PMCID: PMC5244888 DOI: 10.14309/crj.2017.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022] Open
Abstract
Biliary leaks are uncommon but morbid complications of pancreaticoduodenectomies, which have historically been managed with percutaneous drainage, reoperation, or a combination of both. We report a de novo percutaneous-endoscopic hepaticojejunostomy from an anomalous right hepatic duct injured during pancreaticoduodenectomy to the afferent bowel limb. The percutaneous-endoscopic hepaticojejunostomy was stented to allow for tract formation with successful stent removal after 5.5 months. One year after the creation of the percutaneous-endoscopic hepaticojejunostomy, the patient remains clinically well without evidence of biliary leak or obstruction.
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28
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Okhotnikov OI, Yakovleva MV, Grigoriev SN. [Antegrade endobiliary interventions in undilated bile ducts]. Khirurgiia (Mosk) 2017:42-47. [PMID: 28091456 DOI: 10.17116/hirurgia20161242-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To show advisability of antegrade transhepatic approach to bile ducts for benign and malignant biliary diseases if endoscopic technique is impossible or ineffective. MATERIAL AND METHODS 38 patients underwent external biliary drainage followed by endobiliary interventions for the period 2009-2016. RESULTS In all patients treatment was effective and included following manipulations: antegrade balloon dilatation of stricture of biliodigestive anastomosis, papillodilatation, antegrade dislocation of calculuses from common bile duct to duodenum. There were 2 cases of complications after antegrade interventions. 1 woman died from severe pancreatic necrosis. CONCLUSION Percutaneous transhepatic cholangiostomy on undilated bile ducts is effective for temporary biliary drainage in closure of external duodenal or biliary fistula, treatment of intra-abdominal bilema. The method is indicated in elective endobiliary interventions for choledocholithiasis management, elimination of stricture of biliodigestive anastomosis of major duodenal papilla if endoscopic or conventional approaches are impossible or ineffective.
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Affiliation(s)
- O I Okhotnikov
- Department of Endovascular Diagnostics and Treatment #2 of the Kursk Regional Clinical Hospital; Department of Radiological Diagnostics and Therapy and Department of Surgical Diseases of the Faculty of Postgraduate Education, Kursk State Medical University of Ministry of Health of the Russian Federation, Kursk, Russia
| | - M V Yakovleva
- Department of Endovascular Diagnostics and Treatment #2 of the Kursk Regional Clinical Hospital; Department of Radiological Diagnostics and Therapy and Department of Surgical Diseases of the Faculty of Postgraduate Education, Kursk State Medical University of Ministry of Health of the Russian Federation, Kursk, Russia
| | - S N Grigoriev
- Department of Endovascular Diagnostics and Treatment #2 of the Kursk Regional Clinical Hospital; Department of Radiological Diagnostics and Therapy and Department of Surgical Diseases of the Faculty of Postgraduate Education, Kursk State Medical University of Ministry of Health of the Russian Federation, Kursk, Russia
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29
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Ji G, Zhu F, Wang K, Jiao C, Shao Z, Li X. A giant and insidious subphrenic biloma formation due to gallbladder perforation mimicking biliary cystic tumor: A case report. Mol Clin Oncol 2017; 6:71-74. [PMID: 28123732 PMCID: PMC5244985 DOI: 10.3892/mco.2016.1075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/20/2016] [Indexed: 12/11/2022] Open
Abstract
Gallbladder perforation (GBP) represents a rare, but potentially life-threatening, complication of acute cholecystitis. GBP is subdivided into three categories whereas the development of biloma is extremely rare. The present case study reports on a 40-year-old man with a 10-year history of calculus cholecystitis, who was referred to The First Affiliated Hospital of Nanjing Medical University (Nanjing, China) for the surgical treatment of an emerging massive hepatic entity with insidious symptoms and normal laboratory tests. A preoperative imaging study demonstrated the collection with internal septations and mural nodules, but no visible communication with the biliary system. Given the suspected biliary cystic tumor, a laparotomy was performed and the lumen was scattered with papillae. An intraoperative frozen section examination illustrated a simple hepatic cyst. Biochemical analysis of the collection and histopathology of the gallbladder and capsule substantiated the diagnosis of biloma formation due to GBP. The purpose of the present case report was to demonstrate how a pinhole-sized perforation with extravasation of unconcentrated bile from the gallbladder may result in insidious clinical presentation and an undetected leak site. According to the clinicopathological characteristics and composition, formation of biloma should be classified as type IV GBP. To differentiate bilomas with intracystic septations and mural nodules from BCTs is difficult via a preoperative examination, and the definitive diagnosis should be based on a histological examination. Laparotomy with frozen section examination may be the optimal approach in such a case.
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Affiliation(s)
- Guwei Ji
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Feipeng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Ke Wang
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Chenyu Jiao
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Zicheng Shao
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
| | - Xiangcheng Li
- Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R. China
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Gu Y, Wang L, Zhao L, Liu Z, Luo H, Tao Q, Zhang R, He S, Wang X, Huang R, Zhang L, Pan Y, Guo X. Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study. BMC Gastroenterol 2016; 16:105. [PMID: 27565717 PMCID: PMC5002125 DOI: 10.1186/s12876-016-0522-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/16/2016] [Indexed: 12/27/2022] Open
Abstract
Background Plastic and covered metal stents need to be removed or exchanged within appropriate time in case of undesirable complications. However, it is not uncommon that patients do not follow the recommendation for further stent management after Endoscopic Retrograde Cholangiopancreatography (ERCP). The effect of short message service (SMS) intervention monthly on the stent removal/exchange adherence in patients after ERCP is unknown at this time. Methods A prospective, randomized controlled study was conducted. After receiving regular instructions, patients were randomly assigned to receive SMS reminding monthly (SMS group) for stent removal/exchange or not (control group). The primary outcome was stent removal/exchange adherence within appropriate time (4 months for plastic stent or 7 months for covered stent). Multivariate analysis was performed to assess factors associated with stent removal/exchange adherence within appropriate time. Intention-to-treat analysis was used. Results A total of 48 patients were randomized, 23 to the SMS group and 25 to the control. Adherence to stent removal/exchange was reported in 78.2 % (18/23) of patients receiving the SMS intervention compared with 40 % (10/25) in the control group (RR 1.98, 95 % CI 1.16–3.31; p = 0 · 010). Among patients with plastic stent insertion, the median interval time from stent implantation to stent removal/exchange were 90 days in the SMS group and 136 days in the control respectively (HR 0.36, 95 % CI 0.16–0.84, p = 0.018). No difference was found between the two groups regarding late-stage stent-related complications. The rate of recurrent abdominal pain tended to be lower in SMS group without significant difference (8.7 vs 28 %, p = 0.144). Multivariate logistic regression analyses revealed that SMS reminding was the only factor associated with adherence of stent removal/exchange (OR 6.73, 95 % CI 1.64–27.54, p = 0.008). Conclusion This first effectiveness trial demonstrated that SMS reminding monthly could significantly increase the patient adherence to stent removal/exchange after ERCP. Trial registration The study was respectively registered on July 10 in 2016 at ClinicalTrials.gov (NCT02831127).
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Affiliation(s)
- Yong Gu
- Department of Gastroenterology, the first affiliated hospital of Xi'an Jiao Tong university, Xi'an, China.,Digestive System Department, Shaanxi Provincial Crops Hospital of Chinese People's Armed Police Force, Xi'an, China
| | - Limei Wang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Lina Zhao
- Department of Radiotherapy, Xijing Hospital, Xian, China
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Hui Luo
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Qin Tao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Rongchun Zhang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Shuixiang He
- Department of Gastroenterology, the first affiliated hospital of Xi'an Jiao Tong university, Xi'an, China
| | - Xiangping Wang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Rui Huang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Linhui Zhang
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Yanglin Pan
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
| | - Xuegang Guo
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shannxi, China.
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Chok KSH, Lo CM. Biliary complications in right lobe living donor liver transplantation. Hepatol Int 2016; 10:553-558. [PMID: 26932842 DOI: 10.1007/s12072-016-9710-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/03/2016] [Indexed: 12/13/2022]
Abstract
Living donor liver transplantation is an alternative to deceased donor liver transplantation in the face of insufficient deceased donor liver grafts. Unfortunately, the incidence of biliary complication after living donor liver transplantation is significantly higher than that after deceased donor liver transplantation using grafts from non-cardiac-death donations. The two most common biliary complications after living donor liver transplantation are bile leakage and biliary anastomotic stricture. Early treatment with endoscopic and interventional radiological approaches can achieve satisfactory outcomes. If treatment with these approaches fails, the salvage measure for prompt rectification will be surgical revision, which is now seldom performed. This paper also discusses risk factors in donor biliary anatomy that can affect recipients.
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Affiliation(s)
- Kenneth S H Chok
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
| | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Aytaç HÖ, Çalışkan K. A Rare Cause of Acute Pancreatitis: Unexpected Travel of the Biliary Catheter. Balkan Med J 2016; 33:117-8. [PMID: 26966629 DOI: 10.5152/balkanmedj.2015.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/23/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hüseyin Özgür Aytaç
- Department of General Surgery, Başkent University Faculty of Medicine, Adana, Turkey
| | - Kenan Çalışkan
- Department of General Surgery, Başkent University Faculty of Medicine, Adana, Turkey
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Memeo R, Piardi T, Sangiuolo F, Sommacale D, Pessaux P. Management of biliary complications after liver transplantation. World J Hepatol 2015; 7:2890-2895. [PMID: 26689137 PMCID: PMC4678375 DOI: 10.4254/wjh.v7.i29.2890] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/27/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023] Open
Abstract
Biliary complications (BC) currently represent a major source of morbidity after liver transplantation. Although refinements in surgical technique and medical therapy have had a positive influence on the reduction of postoperative morbidity, BC affect 5% to 25% of transplanted patients. Bile leak and anastomotic strictures represent the most common complications. Nowadays, a multidisciplinary approach is required to manage such complications in order to prevent liver failure and retransplantation.
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Lorenz JM. The Role of Interventional Radiology in the Multidisciplinary Management of Biliary Complications After Liver Transplantation. Tech Vasc Interv Radiol 2015; 18:266-75. [DOI: 10.1053/j.tvir.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Shimizu H, Kato A, Takayashiki T, Kuboki S, Ohtsuka M, Yoshitomi H, Furukawa K, Miyazaki M. Peripheral portal vein-oriented non-dilated bile duct puncture for percutaneous transhepatic biliary drainage. World J Gastroenterol 2015; 21:12628-12634. [PMID: 26640339 PMCID: PMC4658617 DOI: 10.3748/wjg.v21.i44.12628] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/31/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of peripheral portal vein (PV)-oriented non-dilated bile duct (BD) puncture for percutaneous transhepatic biliary drainage (PTBD).
METHODS: Thirty-five patients with non-dilated BDs underwent PTBD for the management of various biliary disorders, including benign bilioenteric anastomotic stricture (n = 24), BD stricture (n = 5) associated with iatrogenic BD injury, and postoperative biliary leakage (n = 6). Under ultrasonographic guidance, percutaneous transhepatic puncture using a 21-G needle was performed along the running course of the peripheral targeted non-dilated BD (preferably B6 for right-sided approach, and B3 for left-sided approach) or along the accompanying PV when the BD was not well visualized. This technique could provide an appropriate insertion angle of less than 30° between the puncture needle and BD running course. The puncture needle was then advanced slightly beyond the accompanying PV. The needle tip was moved slightly backward while injecting a small amount of contrast agent to obtain the BD image, followed by insertion of a 0.018-inch guide wire (GW). A drainage catheter was then placed using a two-step GW method.
RESULTS: PTBD was successful in 33 (94.3%) of the 35 patients with non-dilated intrahepatic BDs. A right-sided approach was performed in 25 cases, while a left-sided approach was performed in 10 cases. In 31 patients, the first PTBD attempt proved successful. Four cases required a second attempt a few days later to place a drainage catheter. PTBD was successful in two cases, but the second attempt also failed in the other two cases, probably due to poor breath-holding ability. Although most patients (n = 26) had been experiencing cholangitis with fever (including septic condition in 8 cases) before PTBD, only 5 (14.3%) patients encountered PTBD procedure-related complications, such as transient hemobilia and cholangitis. No major complications such as bilioarterial fistula or portal thrombosis were observed. There was no mortality in our series.
CONCLUSION: Peripheral PV-oriented BD puncture for PTBD in patients with non-dilated BDs is a safe and effective procedure for BD stricture and postoperative bile leakage.
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Lucatelli P, Corradini SG, Corona M, Corradini LG, Cirelli C, Saba L, Poli E, Fanelli F, Wang H, Bezzi M, Catalano C. Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage. Cardiovasc Intervent Radiol 2015; 39:746-755. [PMID: 26604112 DOI: 10.1007/s00270-015-1242-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD). METHODS Institutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF. RESULTS Fourteen (14.4%) patients developed IF and 17 (17.5%) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95% CI 2.658-1510.055; P = 0.010) and low INR (OR 4.7 × 10(-4); 95% CI 0.000-0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95% CI 1.161-17.992; P = 0.030). CONCLUSIONS The amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Stefano Ginanni Corradini
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Mario Corona
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Ginanni Corradini
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Cirelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Edoardo Poli
- Gastroenterology Division, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Fanelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Haofan Wang
- Department of Vascular Interventional Radiology of the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mario Bezzi
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Catalano
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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Xu C, Lv PH, Huang XE, Wang SX, Sun L, Wang FA. Analysis of different ways of drainage for obstructive jaundice caused by hilar cholangiocarcinoma. Asian Pac J Cancer Prev 2015; 15:5617-20. [PMID: 25081675 DOI: 10.7314/apjcp.2014.15.14.5617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma. MATERIALS AND METHODS During the period of January 2006- March 2012, percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) were performed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainage was selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if it could. External drainage was the first choice if infection was diagnosed before the procedure, and a metallic stent was inserted in one week after the infection was under control. Selection by new infections, the degree of bilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients as the parameters was conducted to evaluate the methods of different interventional treatments regarding prognosis of patients with hilar obstruction caused by hilar cholangiocarcinoma. RESULTS PTCD was conducted in 6 patients and PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05). The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). CONCLUSIONS With both drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liver function was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Dahlke MH, Loss M, Schlitt HJ. [Biliary fistulas and biliary congestion after hepatopancreaticobiliary surgery]. Chirurg 2015; 86:547-51. [PMID: 26016714 DOI: 10.1007/s00104-015-0005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Biliary complications after hepatopancreaticobiliary surgery can have severe consequences for the long-term quality of life of patients. Adequate and timely diagnosis of the underlying problem by an experienced surgeon is essential. Ultrasonography, computed tomography, contrast-enhanced fluoroscopy of drains and endoscopic retrograde cholangiopancreatography (ERCP) are helpful examinations that can be employed in a step-wise approach. Early re-do surgery is indicated in the initial postoperative course. Interventional methods, such as ERCP and percutaneous transhepatic cholangiodrainage ( PTCD, plus stents and drains) offer a variety of additional therapeutic options that should be used by the experienced interventionalist in a patient-tailored interdisciplinary fashion.
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Affiliation(s)
- M-H Dahlke
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland,
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Graeter T, Ehing F, Oeztuerk S, Mason RA, Haenle MM, Kratzer W, Seufferlein T, Gruener B. Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study. World J Gastroenterol 2015; 21:4925-4932. [PMID: 25945006 PMCID: PMC4408465 DOI: 10.3748/wjg.v21.i16.4925] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/17/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the long-term hepatobiliary complications of alveolar echinococcosis (AE) and treatment options using interventional methods. METHODS Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm. Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012. Patients' epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters (pre- and post-intervention), medication and surgical treatment (pre- and post-intervention), as well as complications associated with the intervention and patients' subsequent clinical courses were analyzed. In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed. RESULTS Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention. The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years. The most common symptoms were jaundice, abdominal pains, and weight loss. The number of interventions per patient ranged from one to ten. Endoscopic retrograde cholangiopancreatography (ERCP) was most frequently performed in combination with stent placement (82.9%), followed by percutaneous transhepatic cholangiodrainage (31.4%) and ERCP without stent placement (22.9%). In 14.3% of cases, magnetic resonance cholangiopancreatography was performed. A total of eight patients received a biliary stent. A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention. Complications (cholangitis, pancreatitis) occurred in six patients during and in 12 patients following the intervention. The average survival following onset of hepatobiliary complications was 8.8 years. CONCLUSION Hepatobiliary complications occur in about 10% of patients. A significant increase in hepatic transaminase concentrations facilitates the diagnosis. Interventional methods represent viable management options.
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA. Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice. Asian Pac J Cancer Prev 2015; 16:2543-6. [DOI: 10.7314/apjcp.2015.16.6.2543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Xu C, Lv PH, Huang XE, Sun L, Wang SX, Wang FA. Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice. Asian Pac J Cancer Prev 2014; 15:9391-4. [PMID: 25422230 DOI: 10.7314/apjcp.2014.15.21.9391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD) for patients with malignant obstructive jaundice. METHODS During the period of January 2008 and July 2013, internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During the procedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed. External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degree of bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect of IEPTBD. RESULTS Twenty newly onset of infection were recorded after procedure and new infectious rate was 47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 of them (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L before drainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp (P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P < 0.05). CONCLUSIONS The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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Xu C, Huang XE, Wang SX, Lv PH, Sun L, Wang FA, Wang LF. Drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. Asian Pac J Cancer Prev 2014; 15:2681-4. [PMID: 24761884 DOI: 10.7314/apjcp.2014.15.6.2681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundice caused by recurrence and metastasis after primary tumor resection. MATERIALS AND METHODS We collect 42 patients with obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August 2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting (pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapy including intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoing drainage only. We assessed the two kinds of treatment with regard to patient prognosis. RESULTS Both treatments demonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The time to reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survival times were 185 and 128 days, the differences being significant. CONCLUSIONS Interventional drainage in the treatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decrease bilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongs the survival time and period before reobstruction as compared to drainage only.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail :
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