title: Safety and efficacy of the percutaneous treatment of bile leaks in hepaticojejunostomy or split-liver transplantation without dilatation of the biliary tree.
abstract: Biliary leaks complicating hepaticojejunostomy (HJA) or fistulas from cut surface are severe complications after liver transplantation (LT) and split-liver transplantation (SLT). The aim of the study was to describe our experience about the safety and efficacy of radiological percutaneous treatment without dilatation of intrahepatic biliary ducts. From 1990 to 2006, 1595 LTs in 1463 patients were performed in our center. In 1199 LTs (75.2%), a duct-to-duct anastomosis was performed, and in 396 (24.8%), an HJA was performed. One hundred twenty-nine anastomotic or cut-surface bile leakages occurred in 115 patients. Sixty-two biliary leaks occurred in 54 patients with HJA; in 48 cases, an anastomotic fistula was found. Cut-surface fistulas occurred in 14 cases: 5 in right SLTs and 5 in left SLTs. Twenty-two patients were treated with 23 percutaneous approaches for 17 HJA fistulas and 6 cut-surface leaks without intrahepatic bile duct dilatation. Two percutaneous therapeutic approaches were used: percutaneous transhepatic biliary drainage (PTBD) for fistula alone and PTBD with percutaneous drainage of biliary collection in patients with both complications. PTBD was successful in 21 cases (91.3%); the median delay from catheter insertion and leak resolution was 10.3 days (range: 7-41). The median maintenance of drainage was 14.8 days. In 1 patient, fistula recurrence after PTBD needed a surgical approach; after that, an anastomotic fistula was still found, and a new PTBD was successfully performed. In another patient, PTBD was immediately followed by retransplantation for portal vein thrombosis. There were no complications related to the interventional procedure. In conclusion, biliary fistulas after HJA in LT or after SLT can be successfully treated by PTBD. The absence of enlarged intrahepatic biliary ducts should not be a contraindication for percutaneous treatment.
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University of Torino, Turin, Italy.
authors.forename: Dorico
authors.initials: D
authors.lastname: Righi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franchello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ricchiuti
authors.forename: Andrea Doriguzzi
authors.initials: AD
authors.lastname: Breatta
authors.forename: Karine
authors.initials: K
authors.lastname: Versace
authors.forename: Amedeo
authors.initials: A
authors.lastname: Calvo
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: P
authors.initials: P
authors.lastname: Fonio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gandini
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D002404:Catheterization; D002758:Cholangiography; D004322:Drainage / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D015641:Radiography, Interventional; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome