TY - JOUR
T1 - Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage
AU - Henry, Anne Claire
AU - Smits, F. Jasmijn
AU - van Lienden, Krijn
AU - van den Heuvel, Daniel A. F.
AU - Hofman, Lieke
AU - Busch, Olivier R.
AU - van Delden, Otto M.
AU - Zijlstra, I. Jsbrand A.
AU - Schreuder, Sanne M.
AU - Lamers, Armand B.
AU - van Leersum, Marc
AU - van Strijen, Marco J. L.
AU - Vos, Jan A.
AU - te Riele, Wouter W.
AU - Molenaar, I. Quintus
AU - Besselink, Marc G.
AU - van Santvoort, Hjalmar C.
N1 - Funding Information: ACH, FJS, KVL, WTR, IQM and HCvS contributed to the conception and design of the work. All authors contributed to patient recruitment and data acquisition. ACH performed statistical analysis and data analysis. ACH drafted the manuscript. All authors had substantial contribution to interpretation of the data, added important intellectual content to the work and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work and agree that no questions remain related to the accuracy or integrity of any part of the work. Publisher Copyright: © 2021 International Hepato-Pancreato-Biliary Association Inc.
PY - 2021
Y1 - 2021
N2 - Background: Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication. Methods: All patients undergoing PTBD for leakage after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014–2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage. Results: Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21–60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2). Conclusion: Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.
AB - Background: Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. This study evaluated technical and clinical outcomes of PTBD for this indication. Methods: All patients undergoing PTBD for leakage after pancreatoduodenectomy were retrospectively evaluated in two tertiary pancreatic centers (2014–2019). Technical success was defined as external biliary drainage. Clinical success was defined as discharge with a resolved leak, without additional surgical interventions for anastomotic leakage other than percutaneous intra-abdominal drainage. Results: Following 822 pancreatoduodenectomies, 65 patients (8%) underwent PTBD. Indications were leakage of the pancreaticojejunostomy (n = 25; 38%), hepaticojejunostomy (n = 15; 23%) and of both (n = 25; 38%). PTBD was technically successful in 64 patients (98%) with drain revision in 40 patients (63%). Clinical success occurred in 60 patients (94%). Leakage resolved after median 33 days (IQR 21–60). PTBD related complications occurred in 23 patients (35%), including cholangitis (n = 14; 21%), hemobilia (n = 7; 11%) and PTBD related bleeding requiring re-intervention (n = 4; 6%). In hospital mortality was 3% (n = 2). Conclusion: Although drain revisions and complications are common, PTBD is highly feasible and appears to be effective in the treatment of biliopancreatic leakage after pancreatoduodenectomy.
UR - http://www.scopus.com/inward/record.url?scp=85115317618&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hpb.2021.08.941
DO - https://doi.org/10.1016/j.hpb.2021.08.941
M3 - Article
C2 - 34556407
SN - 1365-182X
JO - HPB
JF - HPB
ER -