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Extraluminal recanalization for postoperative biliary obstruction using transseptal needle.
Hiroki Horinouchi1,2, Eisuke Ueshima3, Keitaro Sofue3
1Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Japan. hiro.horinouchi@gmail.com.
Surgical Case Reports
|December 3, 2020
Summary
Extraluminal recanalization using a transseptal needle offers a novel approach for treating complete biliary obstruction when standard methods fail. This technique successfully restored bile flow in a challenging postoperative case, avoiding recurrence.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Surgical Oncology
Background:
- Postoperative biliary strictures often result from bile duct injuries or anastomosis issues.
- Endoscopic therapy is the primary treatment for benign biliary strictures due to its minimally invasive nature.
- Complete biliary obstruction presents significant challenges for conventional recanalization techniques.
Purpose of the Study:
- To describe a novel extraluminal recanalization technique for managing complete postoperative biliary obstruction.
- To evaluate the efficacy and safety of transseptal needle-guided recanalization in a complex case.
Main Methods:
- A 66-year-old patient with complete biliary obstruction post-hepatocellular carcinoma surgery underwent extraluminal recanalization.
- A transseptal needle was used percutaneously to access the obstructed right hepatic duct, guided by an inflated balloon.
- An internal-external biliary drainage tube was successfully placed, followed by tract dilation and endoscopic internalization.
Main Results:
- The extraluminal recanalization procedure was technically successful, with no immediate complications.
- The patient showed no signs of biliary obstruction at the 1-year follow-up.
- Hepatocellular carcinoma recurrence was also not observed during the follow-up period.
Conclusions:
- Transseptal needle-guided extraluminal recanalization is a viable alternative for rigid biliary obstruction.
- This technique provides a solution when conventional endoscopic and percutaneous methods are unsuccessful.
