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Open Access 01-04-2015 | Pictorial Review

Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review

Authors: Giovanni Mauri, Chiara Mattiuz, Luca Maria Sconfienza, Vittorio Pedicini, Dario Poretti, Fabio Melchiorre, Umberto Rossi, Fabio Romano Lutman, Marco Montorsi

Published in: Insights into Imaging | Issue 2/2015

Abstract

Pancreatic resections are surgical procedures associated with high incidence of complications, with relevant morbidity and mortality even at high volume centres. A multidisciplinary approach is essential in the management of these events and interventional radiology plays a crucial role in the treatment of patients developing post-surgical complications. This paper offers an overview on the interventional radiological procedures that can be performed to treat different type of complications after pancreatic resection. Procedures such as percutaneous drainage of fluid collections, percutaneous transhepatic biliary procedures, arterial embolisation, venous interventions and fistula embolisation are viable treatment options, with fewer complications compared with re-look surgery, shorter hospital stay and faster recovery. A selection of cases of complications following pancreatic surgery managed with interventional radiological procedure are presented and discussed.

Teaching Points

• Interventional radiology is crucial to treat complications after pancreatic surgery

• Percutaneous drainage of collections can be performed under ultrasound or computed tomography guidance

• Percutaneous biliary procedures can be used to treat biliary complications

• Venous procedures can be performed effectively through transhepatic or transjugular access

• Fistulas can be treated effectively by percutaneous embolisation

Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’Graggen K (2003) Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 138(12):1310–1314

Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3):248–257

Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4(6):567–579

Gervais DA, Fernandez-del Castillo C, O’Neill MJ, Hahn PF, Mueller PR (2001) Complications after pancreatoduodenectomy: imaging and imaging-guided interventional procedures. Radiographics 21(3):673–690

Zink SI, Soloff EV, White RR et al (2009) Pancreaticoduodenectomy: frequency and outcome of post-operative imaging-guided percutaneous drainage. Abdom Imaging 34(6):767–771

Cozzi G, Severini A, Civelli E et al (2006) Percutaneous transhepatic biliary drainage in the management of postsurgical biliary leaks in patients with nondilated intrahepatic bile ducts. Cardiovasc Intervent Radiol 29(3):380–388

Pedicini V, Poretti D, Mauri G et al (2010) Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results. Eur Radiol 20(5):1061–1068

Winter JM, Cameron JL, Yeo CJ, Lillemoe KD, Campbell KA, Schulick RD (2008) Duodenojejunostomy leaks after pancreaticoduodenectomy. J Gastrointest Surg 12(2):263–269

Shrikhande SV, D’Souza MA (2008) Pancreatic fistula after pancreatectomy: evolving definitions, preventive strategies and modern management. World J Gastroenterol 14(38):5789–5796

10.

Cozzaglio L, Cimino M, Mauri G et al (2011) Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula. J Gastrointest Surg 15:1977–1981

11.

Kim JH, Ko GY, Sung KB et al (2008) Bile leak following living donor liver transplantation: clinical efficacy of percutaneous transhepatic treatment. Liver Transpl 14:1142–1149

12.

Mauri G, Sconfienza LM (2014) Few comments on “Defining treatment and outcomes of hepaticojejunostomy failure following pancreaticoduodenectomy”. J Gastrointest Surg 18(4):880–881

13.

Mauri G, Michelozzi C, Poretti D et al (2013) Bioabsorbable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: preliminary experience. Eur Radiol 23(12):3304–3310

14.

Mauri G, Sconfienza LM (2013) A few thoughts on “Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review” Insights. Imaging 4(2):253

15.

Blanc T, Cortes A, Goere D et al (2007) Hemorrhage after pancreaticoduodenectomy: when is surgery still indicated? Am J Surg 194(1):3–9

16.

Limongelli P, Khorsandi SE, Pai M et al (2008) Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis. Arch Surg 143(10):1001–1007

17.

Yekebas EF, Wolfram L, Cataldegirmen G et al (2007) Postpancreatectomy hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 246(2):269–280

18.

Mauri G, Monti L, Pedicini V (2011) Interventional management of in-stent thrombosis after superior mesenteric vein stenting. EJVES Extra 22(3):27–29

19.

Baker TA, Aaron JM, Borge M, Pierce K, Shoup M, Aranha GV (2008) Role of interventional radiology in the management of complications after pancreaticoduodenectomy. Am J Surg 195(3):386–390

20.

Sohn TA, Yeo CJ, Cameron JL et al (2003) Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. J Gastrointest Surg 7(2):209–219

21.

Lee HG, Heo JS, Choi SH, Choi DW (2010) Management of bleeding from pseudoaneurysms following pancreaticoduodenectomy. World J Gastroenterol 16(10):1239–1244

22.

Rossi UG, Seitun S, Ferro C (2013) Endovascular embolization of a third jejunal artery aneurysm: isolation techinique using the Amplatzer vascular plug 4. Catheter Cardiovasc Interv 81(6):1049–1052

23.

Miura F, Asano T, Amano H et al (2009) Management of postoperative arterial haemorrhage after pancreato-biliary surgery according to the site of bleeding: re-laparotomy or interventional radiology. J Hepatobiliary Pancreat Surg 16(1):56–63

24.

Sconfienza LM, Mauri G, Grossi F et al (2013) Pleural and peripheral lung lesions: comparison of US- and CT-guided biopsy. Radiol 266(3):930–935

25.

Gwon DI, Ko GY, Sung KB, Kim JH, Yoon HK (2011) Percutaneous transhepatic treatment of postoperative bile leaks: prospective evaluation of retrievable covered stent. J Vasc Interv Radiol 22(1):75–83

26.

Shimada H, Endo I, Shimada K, Matsuyama R, Kobayashi N, Kubota K (2012) The current diagnosis and treatment of benign biliary stricture. Surg Today 42:1143–1153

27.

Mueller PR, vanSonnenberg E, Ferrucci JT Jr, Weyman PJ, Butch RJ, Malt RA et al (1986) Biliary stricture dilatation: multicenter review of clinical management in 73 patients. Radiol 160(1):17–22

28.

Born P, Rosch T, Bruhl K et al (1999) Long-term results of endoscopic and percutaneous transhepatic treatment of benign biliary strictures. Endosc 31(9):725–731

29.

Krokidis M, Orgera G, Rossi M, Matteoli M, Hatzidakis A (2013) Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Insights Imaging 4:77–84

30.

Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy haemorrhage (PPH): an International Study Group of Pancretic Surgery (ISGPS) definition. Surg 142(1):20–25

31.

Mauri G, Sconfienza LM, Fiore B et al (2013) Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Rad 68(1):59–63

32.

Sconfienza LM, Mauri G (2014) Interventional options to treat postoperative duodenal stump leaks. Cardiovasc Intervent Radiol. doi:10.1007/s00270-014-0937-7

33.

Mtsumoto T, Iwaki K, Hagino Y et al (2002) Ethanol injection therapy of an isolated bile duct associated with a biliary-cutaneous fistula. J Gastroenterol Hepatol 17(7):807–810

Title: Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review
Authors: Giovanni Mauri
Chiara Mattiuz
Luca Maria Sconfienza
Vittorio Pedicini
Dario Poretti
Fabio Melchiorre
Umberto Rossi
Fabio Romano Lutman
Marco Montorsi
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 2/2015
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-014-0372-y

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Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review

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