Biliary leakage after the treatment of biliary tract exploration by T tube endoscopic biliary stent: report of one case and the literature review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FENG Yuan ¹ , YANG Junjun ² , YANG Hongchun ¹ ,  PENG Yong ¹

1. Department of Hepatobiliary Surgery, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;
2. Department of Infection, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

PENG Yong, Email: 13508081615@163.com

Keywords：

Biliary leakage; biliary tract exploration; T-tube; biliary sent

DOI：

10.7507/1007-9424.201902047

Video：

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Objective To investigate the clinical effect of biliary stent implantation through T-tube lumen and nasobiliary drainage through intrahepatic bile duct in the treatment of biliary leakage after biliary tract exploration.Methods Retrospective analysis was performed on the clinical data of one case of bile leakage after common bile duct exploration admitted to the Department of Hepatobiliary Surgery of Nanchong Central Hospital in December 2016.Results In this case, the biliary stent was placed in the T-tube lumen and the nasal bile duct was placed in the intrahepatic bile duct for biliary drainage. The guidewire was inserted into the hilum of liver through the tunnel in the T-tube cavity, and nasobiliary drainage was placed to the hilum of liver. In addition, a guide wire was inserted through the T-tube into the duodenum, and a 8.5F plastic stent was placed into the duodenum. One end of the stent was placed in the common bile duct, and the other end was placed in the intestinal cavity for biliary drainage. After drainage, the patient’s bile leakage stopped and the abdominal infection was controlled. Ten days after the biliary stent implantation, the patient was discharged successfully, the T-tube and nasobiliary duct were clamped 20 days after the surgery, and T-tube angiography and abdominal B-ultrasound were performed 2 months later, and it found that the scaffold of the lower common bile duct had fallen off, so removed the T-tube. The patient recovered completely after 2 years of follow-up.Conclusion The means of T-tube tunnel biliary stent and the nasobiliary duct drainage through the intrahepatic bile duct are effective methods to treat biliary leakage, the operations are simple and easy to operate.

Citation： FENG Yuan, YANG Junjun, YANG Hongchun, PENG Yong. Biliary leakage after the treatment of biliary tract exploration by T tube endoscopic biliary stent: report of one case and the literature review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(6): 719-722. doi: 10.7507/1007-9424.201902047 Copy

1.	Dahlke MH, Loss M, Schlitt HJ. Biliary fistulas and biliary congestion after hepatopancreaticobiliary surgery. Chirurg, 2015, 86(6): 547-551.
2.	Kimura T, Kawai T, Ohuchi Y, et al. Non-surgical management of bile leakage after hepatectomy: a single-center study. Yonago Acta Med, 2018, 61(4): 213-219.
3.	Mizumura N, Okumura S, Tsuchihashi H, et al. Spontaneous external biliary fistula arising from an intrahepatic duct. Clin J Gastroenterol, 2018, 11(1): 83-86.
4.	Kolligs FT, Schirra J. Endoscopic management of surgical biliary complications. Z Gastroenterol, 2014, 52(12): 1413-1422.
5.	Yang X, Qiu Y, Wang W, et al. Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis. Medicine (Baltimore), 2017, 96(46): e8774.
6.	Taguchi Y, Ebata T, Yokoyama Y, et al. The determination of bile leakage in complex hepatectomy based on the guidelines of the International Study Group of Liver Surgery. World J Surg, 2014, 38(1): 168-176.
7.	Zhang Q, Wang JX, Wang L, et al. Modified laparoscopic choledocholithotomy T-tube drainage reduces the risk of bile leakage: a surgeon’s experience. Asian J Surg, 2019, [Epub ahead of print].
8.	Mateo Retuerta J, Chaveli Díaz C, Goikoetxea Urdiain A, et al. Perforations following endoscopic retrograde cholangio- pancreatography (ERCP). An Sist Sanit Navar, 2017, 40(1): 145-151.
9.	Kim KH, Kim TN. Endoscopic management of bile leakage after cholecystectomy: a single-center experience for 12 years. Clin Endosc, 2014, 47(3): 248-253.
10.	de Jong EA, Moelker A, Leertouwer T, et al. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts. Dig Surg, 2013, 30(4-6): 444-450.
11.	Oh DW, Lee SK, Song TJ, et al. Endoscopic management of bile leakage after liver transplantation. Gut Liver, 2015, 9(3): 417-423.
12.	Fukuhisa H, Sakoda M, Hiwatashi K, et al. Surgical treatment for the excluded bile leakage from Spiegel lobe after right hemihepatectomy: a case report. Int J Surg Case Rep, 2017, 39: 159-163.
13.	Panaro F, Hacina L, Bouyabrine H, et al. Risk factors for postoperative bile leakage: a retrospective single-center analysis of 411 hepatectomies. Hepatobiliary Pancreat Dis Int, 2016, 15(1): 81-86.
14.	Kubo N, Harimoto N, Shibuya K, et al. Successful treatment of isolated bile leakage after hepatectomy combination therapy with percutaneous transhepatic portal embolization and bile duct ablation with ethanol: a case report. Surg Case Rep, 2018, 4(1): 61.
15.	Kajiwara T, Midorikawa Y, Yamazaki S, et al. Clinical score to predict the risk of bile leakage after liver resection. BMC Surg, 2016, 16(1): 30.
16.	孙登群, 龚仁华, 王敬民, 等. 腹腔镜胆囊切除术后表现不典型胆瘘的原因及防治. 中国普外基础与临床杂志, 2008, 15(4): 278-280.
17.	Braunwarth E, Primavesi F, Göbel G, et al. Is bile leakage after hepatic resection associated with impaired long-term survival? Eur J Surg Oncol, 2019, [Epub ahead of print].
18.	江宗兴, 汪涛, 刘彦莉, 等. 5 例医源性高位胆管损伤合并胆漏的处理. 中国普外基础与临床杂志, 2011, 18(10): 1103-1104.
19.	Murata R, Kamiizumi Y, Ishizuka C, et al. Anterograde bile duct drainage for intractable bile leakage after hepatectomy in a patient with previous pancreatoduodenectomy: a case report. Int J Surg Case Rep, 2019, 55: 121-124.
20.	Sayar S, Olmez S, Avcioglu U, et al. A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage. North Clin Istanb, 2016, 3(2): 104-110.
21.	Yun SU, Cheon YK, Shim CS, et al. The outcome of endoscopic management of bile leakage after hepatobiliary surgery. Korean J Intern Med, 2017, 32(1): 79-84.
22.	Chen XP, Peng SY, Peng CH, et al. A ten-year study on non-surgical treatment of postoperative bile leakage. World J Gastroenterol, 2002, 8(5): 937-942.
23.	毛海香, 朱杰, 张斌, 等. 腹腔镜胆总管一期分层缝合减少术后胆漏的临床观察. 肝胆胰外科杂志, 2019, 31(2): 80-82, 97.
24.	敬东红, 张永华, 张建红. 腹腔镜胆囊切除术胆管损伤及胆漏的防治. 腹腔镜外科杂志, 2017, 22(12): 935-938.
25.	李云峰. 腹腔镜胆囊摘除术后胆漏的相关因素分析. 临床研究, 2018, 26(3): 9-10, 12.

1. Dahlke MH, Loss M, Schlitt HJ. Biliary fistulas and biliary congestion after hepatopancreaticobiliary surgery. Chirurg, 2015, 86(6): 547-551.
2. Kimura T, Kawai T, Ohuchi Y, et al. Non-surgical management of bile leakage after hepatectomy: a single-center study. Yonago Acta Med, 2018, 61(4): 213-219.
3. Mizumura N, Okumura S, Tsuchihashi H, et al. Spontaneous external biliary fistula arising from an intrahepatic duct. Clin J Gastroenterol, 2018, 11(1): 83-86.
4. Kolligs FT, Schirra J. Endoscopic management of surgical biliary complications. Z Gastroenterol, 2014, 52(12): 1413-1422.
5. Yang X, Qiu Y, Wang W, et al. Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis. Medicine (Baltimore), 2017, 96(46): e8774.
6. Taguchi Y, Ebata T, Yokoyama Y, et al. The determination of bile leakage in complex hepatectomy based on the guidelines of the International Study Group of Liver Surgery. World J Surg, 2014, 38(1): 168-176.
7. Zhang Q, Wang JX, Wang L, et al. Modified laparoscopic choledocholithotomy T-tube drainage reduces the risk of bile leakage: a surgeon’s experience. Asian J Surg, 2019, [Epub ahead of print].
8. Mateo Retuerta J, Chaveli Díaz C, Goikoetxea Urdiain A, et al. Perforations following endoscopic retrograde cholangio- pancreatography (ERCP). An Sist Sanit Navar, 2017, 40(1): 145-151.
9. Kim KH, Kim TN. Endoscopic management of bile leakage after cholecystectomy: a single-center experience for 12 years. Clin Endosc, 2014, 47(3): 248-253.
10. de Jong EA, Moelker A, Leertouwer T, et al. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts. Dig Surg, 2013, 30(4-6): 444-450.
11. Oh DW, Lee SK, Song TJ, et al. Endoscopic management of bile leakage after liver transplantation. Gut Liver, 2015, 9(3): 417-423.
12. Fukuhisa H, Sakoda M, Hiwatashi K, et al. Surgical treatment for the excluded bile leakage from Spiegel lobe after right hemihepatectomy: a case report. Int J Surg Case Rep, 2017, 39: 159-163.
13. Panaro F, Hacina L, Bouyabrine H, et al. Risk factors for postoperative bile leakage: a retrospective single-center analysis of 411 hepatectomies. Hepatobiliary Pancreat Dis Int, 2016, 15(1): 81-86.
14. Kubo N, Harimoto N, Shibuya K, et al. Successful treatment of isolated bile leakage after hepatectomy combination therapy with percutaneous transhepatic portal embolization and bile duct ablation with ethanol: a case report. Surg Case Rep, 2018, 4(1): 61.
15. Kajiwara T, Midorikawa Y, Yamazaki S, et al. Clinical score to predict the risk of bile leakage after liver resection. BMC Surg, 2016, 16(1): 30.
16. 孙登群, 龚仁华, 王敬民, 等. 腹腔镜胆囊切除术后表现不典型胆瘘的原因及防治. 中国普外基础与临床杂志, 2008, 15(4): 278-280.
17. Braunwarth E, Primavesi F, Göbel G, et al. Is bile leakage after hepatic resection associated with impaired long-term survival? Eur J Surg Oncol, 2019, [Epub ahead of print].
18. 江宗兴, 汪涛, 刘彦莉, 等. 5 例医源性高位胆管损伤合并胆漏的处理. 中国普外基础与临床杂志, 2011, 18(10): 1103-1104.
19. Murata R, Kamiizumi Y, Ishizuka C, et al. Anterograde bile duct drainage for intractable bile leakage after hepatectomy in a patient with previous pancreatoduodenectomy: a case report. Int J Surg Case Rep, 2019, 55: 121-124.
20. Sayar S, Olmez S, Avcioglu U, et al. A retrospective analysis of endoscopic treatment outcomes in patients with postoperative bile leakage. North Clin Istanb, 2016, 3(2): 104-110.
21. Yun SU, Cheon YK, Shim CS, et al. The outcome of endoscopic management of bile leakage after hepatobiliary surgery. Korean J Intern Med, 2017, 32(1): 79-84.
22. Chen XP, Peng SY, Peng CH, et al. A ten-year study on non-surgical treatment of postoperative bile leakage. World J Gastroenterol, 2002, 8(5): 937-942.
23. 毛海香, 朱杰, 张斌, 等. 腹腔镜胆总管一期分层缝合减少术后胆漏的临床观察. 肝胆胰外科杂志, 2019, 31(2): 80-82, 97.
24. 敬东红, 张永华, 张建红. 腹腔镜胆囊切除术胆管损伤及胆漏的防治. 腹腔镜外科杂志, 2017, 22(12): 935-938.
25. 李云峰. 腹腔镜胆囊摘除术后胆漏的相关因素分析. 临床研究, 2018, 26(3): 9-10, 12.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Biliary leakage after the treatment of biliary tract exploration by T tube endoscopic biliary stent: report of one case and the literature review

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