Role of Percutaneous Transhepatic Biliary Endoprostheses with Distal Tube Implantation in the Subcutaneous Space for Management of Patients with Postoperative Biliary Stricture

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 45; no. 6; pp. 615 - 622
• Main Authors: Kawamata, Futoshi, Kamiyama, Toshiya, Nakanishi, Kazuaki, Yokoo, Hideki, Kakisaka, Tatsuhiko, Tahara, Munenori, Kamachi, Hirofumi, Matsusita, Michiaki, Todo, Satoru
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.06.2012
• Subjects: implantation; percutaneous transhepatic biliary endoprosthesis; postoperative biliary duct stricture
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.45.615

The most common complication associated with insertion of a plastic biliary stent due to postoperative bile duct stricture is occlusion. It has been speculated that deodenobiliary reflux through the main duodenal papilla leads to occlusion. Percutaneous transhepatic cholangiodrainage (PTCD) is a viable treatment option for postoperative bile duct stricture, but necessitates long-term external biliary drainage. We report a percutaneous transhepatic procedure for biliary endoprostheses and distal tube implantation in the subcutaneous space. Excellent long-term results and improvement in quality of life were reported in four cases. We attempted percutaneous transhepatic biliary endoprostheses using a biliary decompression tube, devised during or after surgery, and then replaced with CLINY PTCD tube (CREATE MEDIC, Yokohama, Japan). Using the guidewire technique, 7 Fr catheter was introduced initially, and during the process of fistula formation, was gradually replaced up to 12 Fr catheter preserving the papilla of Vater dilation. The tip of the catheter was placed in the common bile duct and the distal end was implanted in the subcutaneous space. Excellent long-term results were obtained, with up to 5 years and 1 month patency. In one case, the tube was occluded with sludge after 15 months, but the tube could be replaced easily and improved the external biliary drainage. Thus, this procedure is useful in cases of occlusion resulting from postoperative bile duct stricture.