The Role of Percutaneous Transhepatic Biliary Interventions in Optimizing Therapeutic Approaches for Biliary Obstructions and Anastomotic Leakage
Kokas Bálint András
Surgical Medicine Division
Dr. Szijártó Attila
SE Sebészeti, Transzplantációs és Gasztroenterológiai Klinika tanterme
2026-03-27 15:00:00
Surgical, interventional treatment and transplantation in abdominal organs
Dr. Szijártó Attila
Dr. Szücs Ákos
Dr. Horváthy Dénes Balázs
Dr. Dede Kristóf
Dr. Ondrejka Pál
Dr. Lintner Balázs
Dr. Csapó Zsolt
Resolution of biliary obstruction and biliary anastomosis leakage is a serious challenge
of hepato-pancreato-biliary interventions, increasing morbidity and mortality. This study
aims to assess the technical success rate, reintervention rate, morbidity, mortality, and the
learning curve of patients treated with PTBD and also evaluates the incidence of
bilioenteric anastomotic leakage, their treatment options, and their outcomes at a highvolume
tertiary referral center. Two retrospective cohort studies were conducted to
analyze the outcomes of patients who underwent PTBD between 2007 and 2018 and
biliary anastomosis formation between 2016 and 2021.
Based on the results the author suggests that PTBD is a safe and effective treatment for
biliary obstructions. It may be chosen as a first‑line modality in cases of high perihilar
obstruction, particularly when sufficient endoscopic expertise is not available. Following
an unsuccessful ERCP, the risk of developing cholangitis is higher; therefore, early PTBD
can play a crucial role. Considering all of this, the author recommends the centralized
management of perihilar obstructions. After perihilar resections, the risk of anastomotic
leakage increases. Based on the data presented, routine intraoperative external biliary
drainage is not recommended, especially in cases without liver resection, as we could not
demonstrate that it prevents anastomotic leakage. If intraoperative external biliary
drainage was applied and biliary leakage subsequently developed, the drain may be useful
in the postoperative period, both diagnostically and to facilitate bile diversion.
The author cannot recommend a single clearly preferable modality for the management
of established biliary anastomotic leakage; therefore, individualized decision‑making is
required in every case. In the absence of peritonitis, conservative management and
minimally invasive techniques (e.g., PTBD) have a role, while in cases requiring surgical
intervention, intraoperative transhepatic drainage may also be part of the therapeutic
arsenal.
