Percutaneous Transhepatic Management of Complex Biliary Problems

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Abstract
A series of 27 patients with complex biliary problems secondary to previous biliary operations is presented. The patients are divided into 2 groups: patients with acute perioperative biliary problems, all of whom had biliary leak with abscess, biliary cutaneous fistula and/or stricture following cholecystectomy or common duct exploration; and patients with chronic postoperative biliary problems, all of whom had previous repair of biliary stricture of injuries with late stricture formation. Early management of all patients included placement of a percutaneous biliary stent. Abscesses were drained operatively, and biliary leaks or fistulas were allowed to close spontaneously. Jaundice and cholangitis were allowed to resolve. Following stabilization, management of stricture, if present, was addressed. Eight acute patients had strictures of which 4 were partial and 3 were dilated percutaneously. Four were complete and required operative repair. All 12 chronic patients had strictures of which 6 were partial and sucessfully managed with percutaneous dilatation. Four patients also had common duct stones which were successfully crushed percutaneously. Percutaneous transhepatic drainage apparently offers significant advantages in the early stabilization and treatment of patients with complex biliary problems, and partial structures of the biliary tree may be managed successfully by percutaneous dilatation.