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Percutaneous Biliary Neo-Anastomosis of Inadvertently Operatively Excluded Right Posterior Bile Ducts: A Durable and
D Nakhostin1, Henrik Petrowsky2, G Puippe1
1Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
Purpose:
To evaluate the feasibility and outcome of percutaneous biliary neo-anastomosis (PBNA) by means of fluoroscopy-guided enteral/biliary puncture, followed by temporary percutaneous transhepatic biliary drainage (PTBD).
Materials And Methods:
Four patients (25% female, mean age 56 years) were referred for PBNA (bilio-entero-neo-anastomosis, n = 3; bilio-biliary-neo-anastomosis, n = 1) between 2007 and 2021. They presented with right posterior bile duct exclusion and bile leakage after major liver or pancreatic surgery, or hemiliver transplant. After puncture of the excluded/leaking bile duct, neo-anastomosis was performed under fluoroscopic guidance using the back end of a 0.018″ guidewire (n = 3) or a vascular reentry device (n = 1). PTBDs were inserted to assure PBNA healing.
Results:
Technical success rate was 100%. No complications occurred. All PTBDs were removed (median = 65 days). During a median follow-up of 2.8 years, two patients died due to unrelated causes. No subsequent bile leakages or re-occlusions were observed.
Conclusion:
In conclusion, PBNA is feasible and safe, and offers long-term biliary patency even in liver-transplanted patients.
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