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The role of interventional radiology in the management of refractory bile leaks. Abdom Radiol (NY) 2022; 47:1881-1890. [PMID: 33733336 DOI: 10.1007/s00261-021-03016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Refractory bile leaks represent a damaging sequela of hepatobiliary surgery and direct trauma. Management of bile leaks represents a challenging clinical problem. Despite advances in endoscopic techniques, interventional radiology continues to play a vital role in the diagnosis and management of refractory bile leaks. This article reviews strategies for optimizing the diagnosis and management of bile leaks and provides an overview of management strategies, including the management of complicated biliary leaks.
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Sun Q, Shen Z, Liang X, He Y, Kong D, Midgley AC, Wang K. Progress and Current Limitations of Materials for Artificial Bile Duct Engineering. MATERIALS 2021; 14:ma14237468. [PMID: 34885623 PMCID: PMC8658964 DOI: 10.3390/ma14237468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 01/30/2023]
Abstract
Bile duct injury (BDI) and bile tract diseases are regarded as prominent challenges in hepatobiliary surgery due to the risk of severe complications. Hepatobiliary, pancreatic, and gastrointestinal surgery can inadvertently cause iatrogenic BDI. The commonly utilized clinical treatment of BDI is biliary-enteric anastomosis. However, removal of the Oddi sphincter, which serves as a valve control over the unidirectional flow of bile to the intestine, can result in complications such as reflux cholangitis, restenosis of the bile duct, and cholangiocarcinoma. Tissue engineering and biomaterials offer alternative approaches for BDI treatment. Reconstruction of mechanically functional and biomimetic structures to replace bile ducts aims to promote the ingrowth of bile duct cells and realize tissue regeneration of bile ducts. Current research on artificial bile ducts has remained within preclinical animal model experiments. As more research shows artificial bile duct replacements achieving effective mechanical and functional prevention of biliary peritonitis caused by bile leakage or obstructive jaundice after bile duct reconstruction, clinical translation of tissue-engineered bile ducts has become a theoretical possibility. This literature review provides a comprehensive collection of published works in relation to three tissue engineering approaches for biomimetic bile duct construction: mechanical support from scaffold materials, cell seeding methods, and the incorporation of biologically active factors to identify the advancements and current limitations of materials and methods for the development of effective artificial bile ducts that promote tissue regeneration.
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Affiliation(s)
- Qiqi Sun
- Key Laboratory of Bioactive Materials for the Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China; (Q.S.); (D.K.)
| | - Zefeng Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; (Z.S.); (X.L.)
| | - Xiao Liang
- Department of General Surgery, Sir Run-Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; (Z.S.); (X.L.)
| | - Yingxu He
- School of Computing, National University of Singapore, Singapore 119077, Singapore;
| | - Deling Kong
- Key Laboratory of Bioactive Materials for the Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China; (Q.S.); (D.K.)
| | - Adam C. Midgley
- Key Laboratory of Bioactive Materials for the Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China; (Q.S.); (D.K.)
- Correspondence: (A.C.M.); (K.W.)
| | - Kai Wang
- Key Laboratory of Bioactive Materials for the Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China; (Q.S.); (D.K.)
- Correspondence: (A.C.M.); (K.W.)
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Yang A, Mitchell M, Di Capua J, Som A, Huang J, Weissleder R, Kalva S, Uppot R. Microwave Ablation for Resolution of Persistent Biloma Following Hepatectomy and Cholecystectomy: Case Report. Cardiovasc Intervent Radiol 2021; 45:387-390. [PMID: 34741197 PMCID: PMC8570770 DOI: 10.1007/s00270-021-02999-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alan Yang
- Harvard Medical School, 524 Quincy House Mail Center, 58 Plympton Street, Cambridge, MA, 02138, USA.
| | - Matthew Mitchell
- Harvard Medical School, 524 Quincy House Mail Center, 58 Plympton Street, Cambridge, MA, 02138, USA
| | - John Di Capua
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Junjian Huang
- University of Alabama at Birmingham, Birmingham, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, USA
| | - Sanjeeva Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Raul Uppot
- Department of Radiology, Massachusetts General Hospital, Boston, USA
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Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature. J Clin Med 2021; 10:jcm10214841. [PMID: 34768362 PMCID: PMC8584511 DOI: 10.3390/jcm10214841] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.
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Nezami N, Jarmakani H, Arici M, Latich I, Mojibian H, Ayyagari RR, Pollak JS, Perez Lozada JCL. Selective Trans-Catheter Coil Embolization of Cystic Duct Stump in Post-Cholecystectomy Bile Leak. Dig Dis Sci 2019; 64:3314-3320. [PMID: 31123973 DOI: 10.1007/s10620-019-05677-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/16/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Percutaneous drainage is a first-line treatment for bilomas developed post-cholecystectomy in the setting of bile leak from the cystic duct stump. Percutaneous drainage is usually followed by surgical or endoscopic treatment to address the leak. AIMS This study aimed to evaluate outcome of selective coil embolization of the cystic duct stump via the percutaneously placed drainage catheters in patients with post-cholecystectomy bile leak. METHODS Seven patients with persistent bile leak after laparoscopic cholecystectomy who underwent percutaneous catheter placement for biloma/abscess formation in the region of the gallbladder fossa were followed. These patients underwent selective trans-catheter cystic duct stump coil embolization from Feb 2013 to Feb 2019. Procedural management, complications, and success rates were analyzed. RESULTS All patients underwent placement of a percutaneous catheter for drainage of biloma formation in the gallbladder fossa post-cholecystectomy. Selective coil embolization of the cystic duct was performed through the existing percutaneous tract on average 3.5 weeks after percutaneous catheter placement, resulting in resolution of the biloma. All bile leaks were immediately closed. None of the patients showed recurrent bile leak or further clinical symptoms. Coil migration to the common bile duct was diagnosed in a single case, after 2.5 years, with no bile leak reported. CONCLUSIONS Selective trans-catheter coil embolization of the cystic stump is a feasible and safe procedure, which successfully seals leaking cystic duct stumps and can circumvent the need for repeat surgical or endoscopic intervention in selected patient populations.
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Affiliation(s)
- Nariman Nezami
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Haddy Jarmakani
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Melih Arici
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Igor Latich
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Rajasekhara R Ayyagari
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jeffrey S Pollak
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Juan Carlos L Perez Lozada
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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Bressem KK, Erxleben C, Lauscher JC, Günther RW, de Bucourt M, Niehues SM, Vahldiek JL. Successful CT-Guided Obliteration of Isolated Bile Ducts with Ethylene Vinyl Alcohol Copolymer in a Patient with Chronic Bile Leakage after Hepatectomy. J Vasc Interv Radiol 2019; 30:1671-1673. [PMID: 31409565 DOI: 10.1016/j.jvir.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/04/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Keno K Bressem
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Christoph Erxleben
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Johannes C Lauscher
- Department of Surgery, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Rolf W Günther
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Maximilian de Bucourt
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
| | - Janis L Vahldiek
- Department of Radiology, Charité Medical School, Humboldt University, Hindenburgdamm 30, Berlin D-12203, Germany
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Crafa F, Esposito F, Noviello A, Moles N, Coppola Bottazzi E, Lombardi C, Miro A, Lombardi G. How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx®): A proposal of a new technique. Ann Hepatobiliary Pancreat Surg 2018; 22:248-252. [PMID: 30215046 PMCID: PMC6125277 DOI: 10.14701/ahbps.2018.22.3.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/10/2018] [Accepted: 06/14/2018] [Indexed: 12/19/2022] Open
Abstract
Backgrounds/Aims Despite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx®). Methods Two patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx® was carried out under fluoroscopic control. Results Neither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17th and 18th postoperative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes. Conclusions To our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.
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Affiliation(s)
- Francesco Crafa
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Francesco Esposito
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Adele Noviello
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Nicola Moles
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Enrico Coppola Bottazzi
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Carmelo Lombardi
- Department of Radiology, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Antonio Miro
- Oncological and General Surgery Unit, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
| | - Giulio Lombardi
- Department of Radiology, "St. Giuseppe Moscati" Hospital of National Relevance and High Specialty, Avellino, Italy
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Kimura T, Kawai T, Ohuchi Y, Yata S, Adachi A, Takeda Y, Yashima K, Honjo S, Tokuyasu N, Ogawa T. Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study. Yonago Acta Med 2018. [DOI: 10.33160/yam.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Takayoshi Kimura
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tsuyoshi Kawai
- †Division of Radiology, Tottori Prefectural Kousei Hospital, Kurayoshi 682-0804, Japan
| | - Yasufumi Ohuchi
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Shinsaku Yata
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Akira Adachi
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Youhei Takeda
- ‡Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Kazuo Yashima
- ‡Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Soichiro Honjo
- §Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- §Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Toshihide Ogawa
- *Division of Radiology, Department of Pathophysiological and Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Percutaneous Treatment of Iatrogenic and Traumatic Injury of the Biliary System. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Dahlke MH, Loss M, Schlitt HJ. [Biliary fistulas and biliary congestion after hepatopancreaticobiliary surgery]. Chirurg 2015; 86:547-51. [PMID: 26016714 DOI: 10.1007/s00104-015-0005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Biliary complications after hepatopancreaticobiliary surgery can have severe consequences for the long-term quality of life of patients. Adequate and timely diagnosis of the underlying problem by an experienced surgeon is essential. Ultrasonography, computed tomography, contrast-enhanced fluoroscopy of drains and endoscopic retrograde cholangiopancreatography (ERCP) are helpful examinations that can be employed in a step-wise approach. Early re-do surgery is indicated in the initial postoperative course. Interventional methods, such as ERCP and percutaneous transhepatic cholangiodrainage ( PTCD, plus stents and drains) offer a variety of additional therapeutic options that should be used by the experienced interventionalist in a patient-tailored interdisciplinary fashion.
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Affiliation(s)
- M-H Dahlke
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland,
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Wible BC, Gooden C, Saucier N, Borsa JJ, Cummings LS, Cho KH. Ethylene-vinyl alcohol copolymer endobiliary obliteration of hepatic segments in a patient with isolated bile leaks. J Vasc Interv Radiol 2014; 25:1821-5. [PMID: 25442143 DOI: 10.1016/j.jvir.2014.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/19/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022] Open
Abstract
A 54-year-old woman with a symptomatic giant hepatic hemangioma underwent an extended left hepatic trisegmentectomy complicated by 250-350 mL/d postoperative bilious drainage. After 5 months of therapy, drainage was unabated, and the patient was no longer a surgical candidate. Sinography revealed three distinct isolated bile duct leaks involving segments 6, 7, and 8. Endobiliary segmentectomy was achieved by obliterating the isolated systems with ethylene-vinyl alcohol copolymer (Onyx; ev3, Plymouth, Minnesota) during three fluoroscopic procedures. Bilious leaks were successfully eliminated, and compensatory hypertrophy of noninvolved liver occurred. At 2 years from the last embolization procedure, the patient remained asymptomatic with no bilious leak.
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Affiliation(s)
- Brandt C Wible
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111.
| | - Christie Gooden
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111
| | - Nathan Saucier
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111
| | - John J Borsa
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111
| | - Lee S Cummings
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111
| | - Kenneth H Cho
- Department of Radiology, St. Luke's Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111
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