Clinical study
Percutaneous Transhepatic Treatment of Postoperative Bile Leaks: Prospective Evaluation of Retrievable Covered Stent

https://doi.org/10.1016/j.jvir.2010.10.004Get rights and content

Abstract

Purpose

To investigate the technical feasibility and clinical efficacy of a retrievable covered stent for treating postoperative bile leaks.

Materials and Methods

This is a prospective study conducted from August 2007 to July 2009. Eleven patients with postoperative bile leak involving bilioenteric anastomosis (n = 8), cystic duct stump (n = 2), and the right intrahepatic bile duct (n = 1) were treated using a percutaneous retrievable covered stent. In five patients (45.5%), there were anastomotic (n = 2) or nonanastomotic (n = 3) strictures in addition to bile leaks. All of the retrievable covered stents were removed percutaneously by retrieval hook wires.

Results

Placement and removal of the retrievable covered stents were technically successful in all study patients. The stents were removed 14–64 days (mean, 31 days) after placement. Stent migration occurred in one (9.1%) of 11 patients. After stent removal, clinical success was achieved in all the study patients. Biliary drainage catheters were withdrawn at a mean of 41 days (range, 20–80 days) after percutaneous transhepatic biliary drainage. During the mean follow-up period of 366 days (range, 215–730 days), recurrence was not noted in any patient.

Conclusions

Placement and removal of a retrievable covered stent is technically feasible and appears to be a clinically effective method for treating postoperative bile leak as well as combined stricture.

Section snippets

Patient Population

From August 2007 to July 2009, 11 patients with postoperative bile leaks were enrolled in this prospective study. The prospective study for use of retrievable covered stents was approved by the Institutional Review Board of our institution, and written informed consent was obtained from each patient or his or her legal guardian.

The study group included seven men and four women ranging in age from 53 to 71 years (median, 63 years). Eleven patients had a bile leak after a bile duct injury from

Percutaneous Approach and Patient Characteristics

Major bile leaks were observed in seven patients (63.6%) and minor bile leaks in four patients (36.4%). The mean interval between surgery and PTBD was 6 ± 4 days (range, 1–13 days). Percutaneous transhepatic access to a peripheral intrahepatic bile duct was achieved successfully in all patients, although pre-PTBD CT showed dilated intrahepatic bile ducts in only two patients (18.2%). A right approach was used in all patients. Bile leaks were detected at the bilioenteric anastomosis in eight

Discussion

To date, a variety of covering materials, such as polyurethane, silicon, and PTFE, have been manufactured and tested. Several studies have compared covered, ie, silicone-covered or polyurethane-covered, and uncovered stents, although the data regarding the efficacy and the safety of these covered stents are controversial (21, 22, 23). Previous investigators have reported tears in the polyurethane and silicon covering membrane during or after stent placement, which resulted in tumor ingrowth (24

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    None of the authors have identified a conflict of interest.

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