Complications of endobiliary minimally invasive percutaneous procedures

Abstract

Objective. To improve the outcomes of percutaneous endobiliary interventions through prediction of postoperative complications and searching for minimally invasive methods of their treatment. Material and methods. Percutaneous en dobiliary interventions have been performed in 2458 patients for the period from 2006 to 2018 including bile duct stenting in 1895 patients. Results. Early postoperative complications included hemobilia (2.1%), abdominal bleeding (0.2%), duodenal bleeding (0.1%), pleuritis (0.9%), abdominal bile leakage (1.5%) and peritonitis (0.8%), liver hematoma (0.7%), right-sided pleuritis (0.9%), pancreatitis (13.8%). In our opinion, these complications are serious and require immediate intensive care and invasive repair. Mortality rate was 8.4% among all patients with early complications and 0.9% among those after endobiliary interventions. Delayed complications of percutaneous transhepatic interventions are migration of stent or drainage tube, drain incrustation, malignant invasion of stent, recurrent cholangitis, cholangiogenic liver abscesses, abdominal abscesses, sepsis, fragmentation of drain or stent, portal vein thrombosis. The most severe late complications (sepsis and portal vein thrombosis) resulted mortality rate 50–60%. Conclusion. Combined dual (ante- and retrograde) biliary approach and control throughout minimally invasive surgery eliminate disadvantages of individual accesses, reduce invasiveness, postoperative morbidity and mortality.