Effective Treatment of Biliopancreatic Fistulas due to Severe Leakage of the Pancreatojejunostomy Following Pancreatic Head Resection by Transhepatic Biliary Drainage: A Case Series of 17 Patients

Löb S1 * # , Anger F 1# , Engelbrecht E1 , Döring A1 , Schollbach J 1 , Germer CT1,2 , Bley T 3 , Klein I 1 and Kickuth R

Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Julius Maximilians University, Germany 2 Comprehensive Cancer Centre Mainfranken, Julius Maximilians University, Germany 3 Department of Diagnostic and Interventional Radiology, Julius-Maximilians University, Germany #Contributed equally

^*Correspondance to: Stefan Löb 

 PDF  Full Text DOI: 10.25107/2474-1647.3088

Abstract

Objective: A combined biliopancreatic fistula due to severe leakage of the pancreatojejunostomy is a rare but clinically challenging postoperative complication after Partial Pancreatoduodenectomy (PPD). The aim of this study was to evaluate the therapeutic efficacy of placing a transhepatic biliary drain in this patient subgroup. Methods: Patients were retrospectively analyzed according to postoperative complications, 30- and 90-day mortality as well as the rate of salvage pancreatectomy, postoperative hemorrhage, and length of hospital stay after treatment of biliopancreatic fistulas. Results: 17 (5.5%) out of 310 patients developed a biliopancreatic fistula after PPD. All patients underwent transhepatic biliary drainage, either by radiological placement (PTBD, n=14) or during surgical re-exploration (STBD, n=3). No pancreatectomy or reoperation had to be performed after initial transhepatic biliary drainage. Postpancreatectomy hemorrhage occurred in 4/17 (23.5%) cases, major complications (Clavien-Dindo ? IIIa) in 6/17 cases (35.3%). Median length of stay was 36 (18 to 71) days. 30-day mortality was zero and 90-day mortality 17.7%. No immediate procedurerelated complication occurred. Conclusion and Advances in Knowledge: The concept of transhepatic biliary drainage is feasible, effective and safe for the treatment of biliopancreatic fistulas. Separation of bile and pancreatic juice represents a novel therapeutic option in selected patients with severe leakage of the pancreatojejunostomy after PPD.

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Cite the article

Löb S, Anger F, Engelbrecht E, Döring A, Schollbach J, Germer CT, et al. Effective Treatment of Biliopancreatic Fistulas due to Severe Leakage of the Pancreatojejunostomy Following Pancreatic Head Resection by Transhepatic Biliary Drainage: A Case Series of 17 Patients. Clin Surg. 2021; 6: 3088..