Treatment Of Biliary Leaks Research Articles

Esophageal Fully-Covered Metal Stent as a Rescue Therapy for a Strasberg Type A Biliary Leak in a Huge Common Bile Duct Dilation.

Treatment of biliary leaks is challenging and complex. Even if endoscopic sphincterotomy with biliary stenting is usually resolutive in restoring the original bile flow, common bile duct (CBD) diameter is crucial in defining the size and features of the stent. Additional factors, such as uncommon anatomical reconstructions due to a previous abdominal surgery, could make the endoscopic approach more difficult, therefore increasing the risk of failure. Many articles deal with uncommon technique adopted to allow an optimal healing of biliary leaks but, thus far, only two reports of biliary stent using an esophageal through-the-scope (TTS), partially-covered, self-expandable metal stent (SEMS) exist in the current literature. This article describes the deployment of an esophageal SEMS into the CBD for a refractory type A Strasberg fistula in a Billroth-II reconstruction. To our knowledge, this is the first report concerning the use of an esophageal stent for CBD drainage in a Billroth-II reconstruction.

Management for biliary complications in post-operation of hilar cholangiocarcinoma

Objective To explore the reasons and preventive measures for biliary complications in post-operation of the hilar cholangiocarcinoma (HCC).Methods From September 1998 to September 2013,we have performed operations for 130 cases of hilar bile duct carcinoma,who were classified into Ⅰ type 11 cases,Ⅱ type 33 cases,Ⅲ type a 36 cases,Ⅲ type b 42 cases,Ⅳ type 8 cases by Bismuth classification.Surgical procedure types included the basic operation type difined as excision with gallbladder,hilar and common bile duct,hepatoduodenal ligament “skeletonized”,and hilar bile duct-jejunum Roux-en-y anastomosis,with or without liver resection.Results The total incidence of biliary complications was 26.2％ (34/130),21 cases of biliary leakage,after drainage of the 19 cases healed in 2 weeks,4 weeks after healing in 2 cases; 7 cases of biliary tract infection,use of antibiotics and cholagogue recovered drug; Stenosis in 3 patients,including 2 cases of reoperation cured,1 case of intrahepatic bile duct after puncture drainage with tube discharge; Gallstone liver abscess (3 cases),after intervention drainage of the whole.This group of 2 cases of death from liver failure,MODS,1 case death.The mortality was 2.3％ (3/130).Conclusions Biliary leakage ranked first in the incidence among biliary complications in post-operation of HCC,and drainage is the best solution for the treatment of biliary leakage. Key words: Bile duct cancer; Surgical procedures; Complications; Bile leakage

Management of biliary complications following damage control surgery for liver trauma.

The liver is the most frequently injured solid intra-abdominal organ. The major cause of early death following severe liver trauma is exsanguination. Although perihepatic packing improves survival in severe liver trauma, this leaves parenchymal damage untreated, often resulting in post-traumatic biliary leakage and a subsequent rise in morbidity. The aim of this study was to analyze the incidence and treatment of biliary leakage following the operative management of liver trauma. Patients presenting between 2000 and 2009 to Erasmus University Medical Centre with traumatic liver injury were identified. Data from 125 patients were collected and analyzed. Sixty-eight (54%) patients required operation. All consecutive patients with post-operative biliary complications were analyzed. Post-operative biliary complications were defined as biloma, biliary fistula, and bilhemia. Ten (15%) patients were diagnosed with post-operative biliary leakage following liver injury. Three patients with a biloma were treated with percutaneous drainage, without further intervention. Seven patients with significant biliary leakage were managed by endoscopic stenting of the common bile duct to decompress the internal biliary pressure. One patient had a relaparotomy and right hemihepatectomy to control biliary leakage and injury of the right hepatic duct. Biliary complications continue to occur frequently following damage control surgery for liver trauma. The majority of biliary complications can be managed without an operation. Endoscopic retrograde cholangiopancreatography (ERCP) and internal stenting represent a safe strategy to manage post-operative biliary leakage and bilhemia in patients following liver trauma. Minor biliary leakage should be managed by percutaneous drainage alone.

Evaluation and Treatment of Biliary Leaks after Gastrointestinal Surgery

IntroductionSince the introduction of laparoscopic cholecystectomy more than two decades ago, the incidence of bile duct injury has remained greater than that established during the era of open cholecystectomy. DiscussionThis article reviews the common causes of bile duct injury during laparoscopic cholecystectomy and makes recommendations that should help prevent these serious injuries from occurring. ConclusionsThe incidence of bile duct injury during laparoscopic cholecystectomy, although greater than during open cholecystectomy, can be minimized using specific operative strategies and dissection principles.

Treatment of Biliary Leakage by an Adjoined Antegrade and Retrograde Percutaneous Transhepatic Cholangio Drainage Approach: A Case Report

In rare cases the treatment of central bile duct leaks is neither possible by joint endosopic and fluoroscopically guided PTCD maneuvers nor by open surgery. We report the successful interventional radiological repair of a defect in the hepatic bile duct bifurcation by means of a new adjoined antegrade and retrograde PTCD approach. The patient had liver metastasis and colon carcinoma treated by hemihepatectomy and secondary radiofrequency ablation. The resulting defect of the central bile ducts was not accessible by PTCD or surgery. Therefore, it was closed by introducing percutaneously a Yamakawa prosthesis using a fluoroscopically guided antegrade and retrograde pull-through technique via the distal common bile duct and the left hepatic bile duct. To the authors knowledge the pull-through-maneuver of a wire from the distal common bile duct to an intrahepatic bile duct using percutaneous approaches has not been described thus far in the literature.

T1566: Fully Covered Self-Expandable Metal Stent Versus Plastic Stent in the Treatment of Biliary Leaks After Cholecystectomy: A Multicenter Study

T1566: Fully Covered Self-Expandable Metal Stent Versus Plastic Stent in the Treatment of Biliary Leaks After Cholecystectomy: A Multicenter Study

Analysis of cause and treatment of biliary leakage after biliary tract surgery

Objective To investigate the cause, therapeutic project and preventive measure of biliary leakage after biliary tract surgery. Methods From 2003 to 2008,17 cases happened postoperative biliary eakage were analyzed retrospectively. Results 17 cases biliary leakage caused by different reason were cured by correlative surgery or non-surgical treatment. No one case died. Conclusion Vigilance operation of biliary tract,individuated therapeutic project, unobstructedpostoperative drainage are key points to treat and prevent biliary leakage after biliary tract surgery. Key words: Diseases of biliary tract; Operation of biliary tract; Biliary leakage

Endoscopic retrograde cholangiopancreatography in managements of postoperative biliary leakage

Objective To evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography （ERCP） for postoperative biliary leakage. Methods Data of 120 patients who developed biliary leakage after hepatobiliary operations and underwent ERCP from January 2003 to December 2008 were retrospectively reviewed. Results There were 71 cases of extra-hepatic biliary leakage （type Ⅰ ）, 39 intra-hepatic biliary leakage （ type Ⅱ） and 10 cystic duct leakage （ type Ⅲ ）, among which endoscopic nasobiliary drainage （ENBD） was performed in 76 cases, endoscopic retrograde biliary stent drainage （ERBD） in 35, ERBD plus ENBD in 3, endoscopic sphincterotomy （EST） in 2, endoscopic metal biliary endoprothesis （EMBE） in 1 and ERCP/elated procedures failed in 3 patients. A total of 98 （81.7%） patients were successfully followed up. Bile leakage was completely controlled in 85 patients （ 86. 7% ） at a mean time of 18.2 ±7.0 d. Leakage of type Ⅲhad the highest cure rate of 100% and the shortest cure time of 8.2 ±3.5 d. For leakage of type Ⅰ and Ⅱ developed after non-liver transplantation operations, the success rate and cure time were significantly better than those after liver transplantation （ P 〈 0.01 ）. Conclusion ERCP is safe and effective for the diagnosis and treatment of biliary leakage after hepatobiliary operations, and can be the first choice of managements, especially in biliary leakage of type Ⅲ. Key words: Cholangiopancreatography, endoscopic retrograde; Postoperative complications ; Biliary leakage

Placement of Covered Self Expandable Metallic Stents in Patients with Biliary Leak: a Pilot Study

Background: Current management of biliary leaks includes ERCP and biliary stenting. Some biliary leaks can nevertheless be challenging and time consuming to treat when using plastic stents, and successful treatment may require a combination of techniques. The ability to place a removable partially covered self-expandable metallic stent (SEMS) may be advantageous in the treatment of biliary leaks, regardless of their location or etiology. The SEMS could easily be deployed to either cover the leak itself or to induce a significant decrease of pressure gradient at the ampullary level, permitting resolution of a duct of Luschka leak.

Endoscopic treatment of biliary leak after laparoscopic cholecistectomy (LC)

Endoscopic treatment of biliary leak after laparoscopic cholecistectomy (LC)

Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage.

To evaluate the efficacy of percutaneous transhepatic biliary drainage in the treatment of biliary leaks. Sixteen patients with a biliary leak involving either the common bile duct (n = 12), the biliary confluence (n = 2), or a hepaticojejunal anastomosis (n = 2) were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to severe acute necrotizing pancreatitis in six patients, while 10 patients had postoperative leak. Percutaneous transhepatic biliary drainage was performed with a 12-F catheter, with two series of side holes positioned on both sides of the extravasation to divert bile flow away from the defect. In 13 patients, the biliary leak healed after drainage (mean duration, 78 days). In four of these patients, a slight residual narrowing of the bile duct was treated by means of either balloon dilation (n = 2) or balloon dilation followed by insertion of a metallic stent (n = 2). All 13 patients remained cured (mean follow-up, 38 months). Two patients with severe acute necrotizing pancreatitis died of complications unrelated to the biliary leak. Vascular complications occurred in two patients, one of whom died after surgical drainage of a subcapsular hematoma. Biliary leaks can be treated successfully by means of percutaneous transhepatic biliary drainage. The procedure is particularly useful when surgical or endoscopic management has failed.

Endoscopic treatment of biliary leakage after laparoscopic cholecytectomy (LC)

Endoscopic treatment of biliary leakage after laparoscopic cholecytectomy (LC)

Endoscopic treatment of biliary leakage after laparoscopic cholecystectomy: Raijam I, Catalano MF, Hirsch GS, et al.Endoscopy 1994;26:741–4

Endoscopic treatment of biliary leakage after laparoscopic cholecystectomy: Raijam I, Catalano MF, Hirsch GS, et al.Endoscopy 1994;26:741–4

Endoscopic Treatment of Biliary Leakage after Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is an effective and safe treatment for uncomplicated symptomatic cholelithiasis. However, biliary tract injury may be more common with this procedure than with open cholecystectomy. We have encountered 17 patients with a biliary leak among 465 patients undergoing laparoscopic cholecystectomy, the diagnosis being established by clinical and radiographic parameters. The most common site of leakage was the cystic duct stump. Patients underwent endoscopic sphincterotomy and biliary stent placement, with an overall success rate of 96%. No morbidity or mortality related to the endoscopic procedures was encountered. We conclude that biliary leakage after laparoscopic cholecystectomy is uncommon. When it occurs, it can be treated safely and efficaciously by endoscopic means.

Treatment of biliary leaks and fistulae by simultaneous percutaneous drainage and diversion

Although biliary fistulae and bilomas are often adequately managed with percutaneous drainage, persistent bile duct leaks are difficult to control. The primary surgical goal in this situation is to decompress the biliary system through diversion of bile flow to facilitate healing of the defect in the bile ducts. We report 3 patients with large biliary duct defects who underwent percutaneous transhepatic cholangiography which demonstrated the site of the biliary leakage. Then, extrapolating the aforementioned surgical tenet to these patients, all 3 were successfully treated with interventional radiologic techniques: simultaneous percutaneous transhepatic biliary diversion to control biliary flow and percutaneous biloma drainage to facilitate closure of the cavity.

Analysis of Causes and Treatment of Biliary Leakage after Hepatobiliary Surgery

Hepatobiliary surgery is very common, and its operation is mainly based on the principle of human anatomy to carry out operations. In the actual operation, if there are no corresponding protective measures, it is easy to damage bile tract and bile duct, even biliary leakage complications will be caused after the surgery, and a certain effect will have on the patient's body and mind. It is necessary to strengthen the prevention and treatment of biliary leakage on the basis of thinking on the causes of bile leakage, and it can reduce the chance of the complications. Therefore, this article mainly focuses on strengthening the analysis and discussion on the cause of biliary leakage after hepatobiliary surgery and the treatment of related aspects.