13- Post-surgical enteric fistulas treatment

Glubran®2 is used in interventional radiology for the treatment of biliary fistulas, but also of enteric ones.Postsurgical biliary fistulas (biliary leaks) have an incidence ranging from 0.1-1.4% after cholecystectomy, to 0.4-3% after cephalo-pancreaticoduodenectomy (PDC), and up to 8% in the liver surgical resection or transplantation (Righi et al., Liver Transpl.
2008; Yeo et al., Ann Surg. 2007; Jukka et al., Surg Endosc. 2007; William et al., Ann Surg. 2002). The post-operative mortality, related to leaking, may reach 19% in transplant patients (Kim et al., Liver Transpl. 2008).
Besides conservative approach, there are other possible therapeutic strategies, such as image-guided percutaneous drainage, endoscopic and / or percutaneous procedures of various types, surgical repair.
The objectives of percutaneous treatments in interventional radiology are (Krokidis M et al., Insights Imaging. 2013):
• dilation of any stenosis coexisting downstream (which increase the
endobiliary pressure and help the bile leakage and bilomas formation);
• diversion of bile from the leakage point;
• complete drainage of any collection;
• sealing / embolization, when possible, of the fistula tract with adhesives or other substances.
The sealing / embolization can be limited to the leakage point (block a hole) or extended to the whole of the affected bile duct segment (segmental ablation), to block the production of bile and induce atrophy in the corresponding liver segment.
However, a selective catheterization is necessary to reach the bile duct, where is the fistula and / or the collection that this feeds, by a percutaneous approach to the biliary system. This can be done directly or through the already positioned abdominal drainage (Saad WE et al., Tech Vasc Interv Radiol . 2008).
The substances used for the sealing / embolization are absolute alcohol (98-99%), spirals and cyanoacrylate or fibrin glues. Other embolizing agents are Gelfoam® (absorbable fibrin sponge) and Onyx® (copolymer ethylene-vinyl-alcohol), commonly used in vascular applications. In qualified Centres, laser is also used……………….Read more