Percutaneous transhepatic biliary drainage as an effective complementary treatment option for clinically relevant biliopancreatic, pancreatic and biliary leakage after pancreaticoduodenectomy

Background Clinically relevant postoperative pancreatic fistula (CR-POPF) and bile leakage (BL) are associated with high morbidity and mortality after pancreaticoduodenectomy (PD). Rescue pancreatectomy for CR-POPF after PD is also associated with major morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) is a well-established treatment option for isolated bile leakage following PD. The efficacy of PTBD as a treatment option for clinically relevant biliopancreatic leakage after PD is still uncertain. Methods Data from 543 patients scheduled for PD between 2014 and 2022 at Uppsala University Hospital, Sweden –– a tertiary referral centre –– were evaluated for clinically significant biliopancreatic, pancreatic or biliary leakage. Patients with unresolved leakage despite percutaneous intra-abdominal drainage were treated with PTBD. This study evaluates the technical success and clinical outcomes of this treatment. Results PD was performed on 483 patients, of whom 83 (17%) had clinically relevant biliary, pancreatic or combined leakage. Thirty-nine (46%) of those with leakage received a PTBD, which was technically successful at the first procedure in 38 (97%) patients. Clinical success –– defined as discharge with closed PTBD, a resolved leak without the need for rescue pancreatectomy or in-hospital mortality –– was achieved in 32 (84%) patients. Two patients required an urgent rescue pancreatectomy without prior PTBD. Conclusion PTBD appears to be an effective complementary treatment method for clinically relevant biliopancreatic leakage after PD. Although promising, PTBD-related complications are common, with 50% requiring drain revision, and thus the treatment should be considered with caution. ​​Trial Registration Not applicable. This​ ​is a retrospective registry-based observational study.