Ethanol ablation for refractory bile leakage after complex hepatectomy.

Area of Science:

• Hepatobiliary surgery
• Interventional radiology
• Gastroenterology

Background:

• Posthepatectomy bile leakage is a common complication after liver surgery.
• Few treatment options exist for refractory bile leakage.
• Ethanol ablation has not been widely reported for this indication.

Purpose of the Study:

• To evaluate the efficacy and safety of ethanol ablation for managing refractory bile leakage after hepatectomy.
• To assess the outcomes of ethanol ablation in patients with severe bile leakage (Grade B2).

Main Methods:

• Retrospective review of patients undergoing hepatobiliary resection with bilioenteric anastomosis.
• Analysis of patients who developed bile leakage (Grades A, B1, B2) and underwent ethanol ablation.
• Absolute ethanol injection into the bile duct during fistulography for treatment.

Main Results:

• Bile leakage occurred in 38.9% of 609 patients; Grade B2 was most frequent after left trisectionectomy.
• 31 patients with Grade B2 leakage received ethanol ablation, starting a median of 34 days post-surgery.
• All patients achieved complete resolution of bile leakage following a median of 3 treatments, with minimal complications (fever, pain).

Conclusions:

• Ethanol ablation is a safe and effective treatment for refractory posthepatectomy bile leakage.
• It offers a viable therapeutic option for patients with persistent bile leaks after liver resection.
• Further studies may confirm its role in managing this challenging complication.