Trans-cystic biliary catheterization and decompression in liver and biliary surgery.

BACKGROUND/AIMS: Trans-cystic biliary catheterization (TCBC) and decompression may be employed to prevent biliary leakage after liver and biliary surgery.

METHODOLOGY: We evaluated medical records of patients that required trans-cystic biliary catheterization between 2001-2009; we retrospectively review prospectively collected data, including patient demographics, operational procedures, cholangiographies and post-operative follow-ups.

RESULTS

Mean age was 54 years (16-80 years) and 63% of patients were female. TCBC was employed only during the operation in 13 patients due to biliary leakage suspicion, but no leakage was detected and cystic canal is ligatured after catheter removal at the same operation. In remaining patients, catheters were placed in the cystic duct and blocked in 1-12 days. Biliary fistula developed in five patients and bile leakage was stopped spontaneously under trans-cystic biliary catheterization and decompression. Three patients were diagnosed to have retained common bile duct stones by cholangiographies and all removed with endoscopic retrograde cholangiopancreatography. Catheters were withdrawn at 19-21 days post-operation. We experienced no TCBC related complications.

CONCLUSIONS

Despite risks and difficulty of TCBC, it helps to demonstrate bile leak sites via trans-cystic flushing and to repair them as well as taking cholangiography, recognizing intra-luminal pathology, and also decompressing biliary system.