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Percutaneous transhepatic management of complex biliary problems.

G D Zuidema, J L Cameron, J V Sitzmann

Annals of Surgery

|May 1, 1983

Summary

Percutaneous transhepatic drainage effectively stabilizes complex biliary problems, including leaks and abscesses. Partial biliary strictures can be successfully treated with percutaneous dilatation, offering a minimally invasive approach.

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Area of Science:

Gastroenterology
Interventional Radiology
Hepatobiliary Surgery

Background:

Complex biliary problems often arise post-operatively, including biliary leaks, abscesses, fistulas, and strictures.
Management of these complications requires addressing acute issues before definitive treatment of chronic sequelae.

Observation:

This study presents 27 patients with complex post-operative biliary issues, divided into acute and chronic groups.
Early management involved percutaneous biliary stenting and operative drainage of abscesses, allowing spontaneous closure of leaks/fistulas.
Jaundice and cholangitis were resolved before addressing strictures.

Findings:

Percutaneous transhepatic drainage facilitated early stabilization in all patients.
Partial biliary strictures in both acute and chronic groups were successfully managed with percutaneous dilatation.

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Complete strictures required operative repair, and common duct stones were managed with percutaneous lithotripsy.

Implications:

Percutaneous transhepatic drainage is advantageous for stabilizing complex biliary problems.
Percutaneous dilatation is an effective treatment for partial biliary strictures.
Minimally invasive percutaneous techniques offer significant benefits in managing post-operative biliary complications.