Biliopancreatic and biliary leak after pancreatoduodenectomy treated by percutaneous transhepatic biliary drainage.

Autor:	Henry AC; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., Smits FJ; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., van Lienden K; Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands., van den Heuvel DAF; Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands., Hofman L; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., Busch OR; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., van Delden OM; Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., Zijlstra IA; Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., Schreuder SM; Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., Lamers AB; Department of Interventional Radiology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., van Leersum M; Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands., van Strijen MJL; Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands., Vos JA; Department of Interventional Radiology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, the Netherlands., Te Riele WW; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., Molenaar IQ; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands., van Santvoort HC; Department of Hepato-Pancreato-Biliary Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, the Netherlands. Electronic address: h.vansantvoort@umcutrecht.nl.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2022 Apr; Vol. 24 (4), pp. 489-497. Date of Electronic Publication: 2021 Sep 06.
DOI:	10.1016/j.hpb.2021.08.941
Abstrakt:	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. (Copyright © 2021 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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