Assessment of Technical and Clinical Success of Percutaneous Transhepatic Biliary Drainage for Postoperative Bile Leaks: A Favorable Alternative to Early Surgical Revision?

Purpose This study aimed to evaluate the role of percutaneous transhepatic biliary drainage (PTBD) with an escalation strategy for managing postoperative bile leaks as an alternative to early surgical revisions. Methods We retrospectively reviewed 24 patients (14 males, 10 females; mean age 69.3 ± 11.7 years, range 45-93) transferred by the Department of Visceral and Abdominal Surgery between January 2018 and October 2021. Twenty-three PTBDs were placed, followed by 107 follow-up biliary interventions using an escalation strategy that involved progressively larger drains (8, 10, 12F) and modified PTBDs with side holes avoiding the insufficiency area. The primary endpoints were technical and clinical success. Technical success was defined as successful PTBD placement with confirmed bile drainage. Clinical success was determined by bile leak resolution, assessed through bile output reduction, normalization of inflammatory markers, and imaging confirmation. Results A total of 141 interventional procedures were performed, including 23 initial PTBD insertions, 107 follow-up controls, and 10 additional ultrasound- or CT-guided drainages. For successfully treated patients, the interventional therapy averaged 72.5 ± 76.2 days, ranging from nine to 239 days. Technical success was 100% in both groups. Clinical success was 93.8% in the primary PTBD group and 14.3% in the secondary PTBD group. Conclusion Our retrospective descriptive case series describes the use of PTBD for postoperative bile leaks, with high technical success and favorable clinical outcomes observed - particularly among patients who received PTBD as the primary intervention. In contrast, patients who underwent PTBD after failed surgical revision appeared to experience higher mortality and more postoperative complications.