Percutaneous biliary intervention as an initial treatment for injury of the bile duct

Abstract

Background: Percutaneous biliary drainage (PTBD) has been used to treat surgical bile duct injuries and as an adjunct to repair surgery.Objective: To present the results of PTDB in a consecutive series of patients with surgical injuries or sequelae of surgical repairs of the bile duct.Material and methods: Patients initially treated with PTBD were analyzed. Strasberg classification was used and recorded: type of operation, surgical approach, number of reoperations, biliary repair attempts and clinical presentation. In patients with bilioenteric continuity, percutaneous biliary treatment was the first option. PTBD was evaluated in the pre, intra and postoperative period and inthe pre dilatation period.Results: At the Hospital Argerich, from 2000 to 2014, 76 patients were included, 68.4% women and 97% post cholecystectomy. The lesions were Type E2 to E5 in 77% of cases. The percentage of patients with controlled symptoms before surgery or percutaneous dilatation was: jaundice 59%, cholestasis 5%, cholangitis 91%, biliary fistula 87%, pruritus 90%, withdrawal hepaticostoma or T-Kehr 91%. In 13 of 16 patients with external biliary fistula, the catheter could be internalized to abdominal cavity. In 70% of 52 operated patients, the catheter facilitated the identification of the proximal biliary duct. In the postoperative period, there were no biliary fistulas of the bilioenteric anastomoses and 3 patients with residual biliary stenosis and 2 with isolated biliary segments were detected and treated.Conclusion: PTBD is helpful in the pre, intra and postoperative treatment of patients with surgical bile duct injuries.