Leakage of Hepaticojejunal Anastomosis: Radiological Interventional Therapy

Hepaticojejunostomy is an established procedure accompanying liver resection as well as hepatobiliary and pancreatic surgery. Typical complications requiring radiological intervention are abscesses and anastomosis leakage. Biliary obstruction and strictures are less frequent indications for interventional radiology since many of them can be treated endoscopically.

Depending on anatomic location, underlying etiology, and complication of leakage, different procedures of interventional radiology are performed: treating abscesses through percutaneous abscess drainage (PAD), handling biliary leakage by percutaneous transhepatic biliary drainage (PTBD) after percutaneous transhepatic cholangiography (PTC), or rarely performed percutaneous stent implantation and internalization after PTC and PAD to treat biliary strictures or to cover the leak. A selective literature search was performed, taking into account recent papers of radiological interventions concerning leakage of hepaticojejunostomy.

Different radiological interventions for the treatment of potentially devastating complications after hepaticojejunostomy are recommended. PAD and PTBD serve either as a definite treatment or as bridging therapy until re-surgery is performed. Complications mainly concern uncontrollable bleeding during the intervention.

Radiological interventions are safe and usable if the indication is meticulously chosen. PAD is one of the most commonly performed procedures by interventional radiologists and a well-established and safe procedure. PTC, PTBD, and biliary stent implantation are important procedures which are required if endoscopic interventions failed or cannot be performed due to postoperatively changed anatomical structures.