Biliary leaks: Treatment by means of percutaneous transhepatic biliary drainage

PURPOSE: To evaluate the efficacy of percutaneous transhepatic biliary drai nage in the treatment of biliary leaks. MATERIALS AND METHODS: Sixteen patients with a biliary leak involving eithe r the common bile duct (n = 12), the biliary confluence (n = 2), or a hepat icojejunal anastomosis (n = 2) were treated by means of percutaneous transh epatic biliary drainage. The biliary leak was due to severe acute necrotizi ng pancreatitis in six patients, while 10 patients had postoperative leak. Percutaneous transhepatic biliary drainage was performed with a 12-F cathet er, with two series of side holes positioned on both sides of the extravasa tion to divert bi le flow away from the defect. RESULTS: In 13 patients, the biliary leak healed after drainage (mean durat ion, 78 days). In four of these patients, a slight residual narrowing of th e bile duct was treated by means of either balloon dilation (n = 2) or ball oon dilation followed by insertion of a metallic stent (n = 2). All 13 pati ents remained cured (mean follow-up, 38 months). Two patients with severe a cute necrotizing pancreatitis died of complications unrelated to the biliar y leak. Vascular complications occurred in two patients, one of whom died a fter surgical drainage of a subcapsular hematoma. CONCLUSION: Biliary leaks can be treated successfully by means of percutane ous transhepatic biliary drainage. The procedure is particularly useful whe n surgical or endoscopic management has failed.