Percutaneous Drainage via the Blind End of the Jejunal Limb for Biliary Leakage After Pancreaticoduodenectomy
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LETTER
Percutaneous Drainage via the Blind End of the Jejunal Limb for Biliary Leakage After Pancreaticoduodenectomy Shohei Chatani1 • Yozo Sato1 • Shinichi Murata1 • Takaaki Hasegawa1 • Hidekazu Yamaura1 • Seiji Natsume2 • Yoshiki Senda2 • Yasuhiro Shimizu2 Yoshitaka Inaba1
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Received: 30 March 2020 / Accepted: 6 April 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
To the Editor, We report our percutaneous drainage method via the blind end of the jejunal limb (BEJL) for hepaticojejunostomy (HJ) leakage after pancreaticoduodenectomy (PD). Four patients with pancreatic or duodenal tumors (3 men and 1 woman; median age of 72.5 [range 67–77] years) underwent percutaneous drainage via the BEJL for HJ leakages following PD from June 2016 to April 2019. All patients underwent PD reconstruction using the modified Child method with surgical fixation of the BEJL to the anterior abdominal wall. Hepaticojejunostomy was performed using an end-to-side configuration without any biliary duct drainage (Fig. 1). All patients were diagnosed with biliary leakage based on the presence of bile in the surgical drain. Before this procedure, various managements such as antibiotic administration, repositioning of the surgical drain, and additional percutaneous drainage were implemented in all patients; however, all of them were ineffective. The median number of days between PD and biliary access via the BEJL was 32 (range 18–55) days. No patient showed intrahepatic biliary duct dilation, and two patients had ascites. All procedures were performed under conscious sedation and local anesthesia. In two patients without pancreatic fistulae, a 0.035-inch hydrophilic guidewire
(Radifocus, Terumo, Tokyo, Japan) was inserted though the external pancreatic duct tube, whereas in the other patients whose pancreatic duct tube could not be removed, nondilated BEJL was punctured using a 21-gauge needle under US or CT guidance. A 0.018-inch guidewire (Radifocus) was inserted to the BEJL and upsized to 0.035inch guidewire using the two-step method. A 6.5-F seeking catheter was advanced to the BEJL along with the guidewire, and retrograde cholangiography was performed. Subsequently, the HJ anastomosis was cannulated using the hydrophilic guidewire, which was exchanged to a 0.035inch super-stiff guidewire (Amplatz extra-stiff wire, COOK Medical, Bloomington, IN), and a 6 or 8-F straight
& Shohei Chatani [email protected] 1
Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
2
Department of Gastroenterological Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
Fig. 1 The schema of PD reconstruction of the modified Child method (red arrow: the BEJL fixed to the abdominal wall, black arrow: hepaticojejunostomy, black arrowhead: the external pancreatic duct tube placed during the surgery)
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S. Chatani et al.: Percutaneou
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