title: Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts.
abstract: OBJECTIVE
  To assess the feasibility of percutaneous transhepatic biliary drainage (PTBD) for the treatment of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts, its efficacy in restoring the integrity of bile ducts, and technical procedures to reduce morbidity.
  
  
  METHODS
  Seventeen patients out of 936 undergoing PTBD over a 20-year period had a noncholestatic liver and were retrospectively reviewed. All patients underwent surgery for cancer and suffered a postsurgical biliary leak of 345 ml/day on average; 71% were in poor condition and required permanent nutritional support. An endoscopic approach failed or was excluded due to inaccessibility of the bile ducts.
  
  
  RESULTS
  Established biliary leaks and site of origin were diagnosed an average of 21 days (range 1-90 days) after surgery. In all cases percutaneous access to the biliary tree was achieved. An external (preleakage) drain was applied in 7 cases, 9 patients had an external-internal fistula bridging catheter, and 1 patient had a percutaneous hepatogastrostomy. Fistulas healed in an average of 31 days (range 3-118 days ) in 15 of 17 patients (88%) following PTBD. No major complications occurred after drainage. Post-PTBD cholangitis was observed in 6 of 17 patients (35%) and was related to biliary sludge formation occurring mostly when drainage lasted >30 days and was of the external-internal type. Median patient survival was 17.7 months and in all cases the repaired biliary leaks remained healed.
  
  
  CONCLUSIONS
  PTBD is a feasible, effective, and safe procedure for the treatment of postsurgical biliary leaks. It is therefore a reliable alternative to surgical repair, which entails longer hospitalization and higher costs.
authors.affiliation: Department of Radiology, Radiologia 3 Unit, National Cancer Institute (Istituto Nazionale Tumori), Milan, Italy, guido.cozzi@istitutotumori.mi.it
authors.forename: Guido
authors.initials: G
authors.lastname: Cozzi
authors.forename: Aldo
authors.initials: A
authors.lastname: Severini
authors.forename: Enrico
authors.initials: E
authors.lastname: Civelli
authors.forename: Marco
authors.initials: M
authors.lastname: Milella
authors.forename: Andrea
authors.initials: A
authors.lastname: Pulvirenti
authors.forename: Monica
authors.initials: M
authors.lastname: Salvetti
authors.forename: Raffaele
authors.initials: R
authors.lastname: Romito
authors.forename: Laura
authors.initials: L
authors.lastname: Suman
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaraviglio
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
mesh_terms: D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D001660:Biliary Tract Diseases / Q000601:surgery*; D002758:Cholangiography; D004322:Drainage / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome