Role of Interventional Radiology in the Management of Postoperative Biliary Complications

Nasif, Hana Hamdy; Abdelmaksoud, Mohamed Hosni Kamel; Shalaby, Mennatallah Hatem; Elsakka, Ahmed Salama Hussein Mohamed

doi:10.21608/ejhm.2018.10734

Role of Interventional Radiology in the Management of Postoperative Biliary Complications

Document Type : Original Article

Authors

¹ Department of Radiology, Faculty of Medicine, Ain Shams University

² Department of Interventional Radiology, Theodore Bilharz research institute, Visiting Scholar, Interventional Radiology, Stanford University, CA, USA

10.21608/ejhm.2018.10734

Abstract

Background: Biliary postoperative complications include biliary stenoses, biliary leaks, fistulas and collection or abscess formation. These complications usually occur due to injury after laparoscopic cholecystectomy, gastric or hepatic resection, bilio-enteric anastomosis and after liver transplantation. In most of the cases a new surgical intervention is not possible. Endoscopic intervention is usually the optimal initial management of these complications; however, in patients with altered enteric passage, tight low biliary stricture, high up obstruction or leakage endoscopic approach becomes impossible. Therefore, the percutaneous trans-hepatic approach is of extreme importance in the diagnosis and treatment of the problem especially in complex cases
Objective: This study aimed to highlight the spectrum of percutaneous cholangiographic findings and methods of treatment of postoperative benign biliary stenoses, biliary leaks and to detect its significance in management of these problems.
Patients and Methods: This study was conducted in Theodor bilharz research institute (TBRI), Egypt from February 2013 to June 2018. 17 patients with benign postoperative biliary complications (stricture and leak) were treated with a percutaneous transhepatic procedure. Only adult patients (age >18 years) were included in the study.
Results: All patients had cholestasis and/or bile leak according to clinical and biologic findings (i.e., jaundice or an episode of cholangitis). Biliary obstruction and/or leak was confirmed by abdominal ultrasonography (US), multidetector computed tomography, and/or magnetic resonance (MR) cholangiography when US results were not conclusive and confirmation of the site & extension of the stricture and/or leak was needed. The results of the present study demonstrated that treatment of post-operative biliary complications (stricture and/or leak) by percutaneous transhepatic procedures was an effective option with acceptable rate of complication.
Conclusion: We concluded that the percutaneous treatment of post- operative biliary complications is an effective alternative to surgery. This method should certainly be preferred when the local conditions were not favorable to a surgical repair, failure of endoscopic approach or when a recurrence was observed after an unsuccessful previous repair. Its advantages compared with surgery were its minimally invasive nature, reduced risk of complications, and the fact that all options remain open in case of failure.

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