Percutaneous Transhepatic Biliary Drainage with the Y-Type Catheter System in Treatment of Patients with Recurrent Bile Duct Strictures

Aim. To evaluate an improved method of percutaneous transhepatic biliary drainage (PTBD) with the Y-type catheter system for patients with post-traumatic recurrent bile duct stricture.
Material and Methods. A retrospective analysis examined management of 11 patients with recurrent hepatico-jejunal anastomosis stricture after iatrogenic injury of bile ducts during laparoscopic cholecystectomy. Recurrent stricture was observed in 5 patients after 1 reconstructive biliary intervention, in 4 patients after 2 operations and in 2 patients after 3 operations. 9 patients from group I were treated with a conventional long-term single drainage technique with continuous daily flushing. Repeated balloon dilatation of stricture and biliary drain exchange were performed every

3 months. 4 patients from group II (including 2 patients with unsuccessful conventional treatment from group I) were treated with the Y-type drainage catheter system achieving permanent dilatation of bile duct stricture. An exchange of this drainage system was done once every 3 months without flushing or fixation to the skin.
Results. Patients from group I demonstrated the residual biliary stricture confirmed by a deformation of balloon catheter within average period of 7.3 months (6–12 months). Cholangitis due to dislocation and obstruction of the drain was observed in 4 patients. Mean overall drainage time was 13.8 months (12–17 months) with clinical follow-up from 4 to 10 years after drain elimination. Symptoms of recurrent stricture were observed in 2 patients after 3 and 4.5 years.
Patients from group II demonstrated complete resolution of cholangiographic signs of stricture within 3 months after PTBD using Y-type catheter system. There were no complications. Mean drainage time was 10.5 months (9–12 months). There were no recurrences in 2, 13, 14 and 16 months after PTBD removal.
Conclusion. PTBD with the Y-type catheter system may be an effective alternative to open reconstructive surgery for some patients with multiple recurrent benign bile duct strictures. In comparison with conventional method, the improved method of PTBD results permanent dilatation of bile duct stricture, reduces risks of treatment-related complications and duration of treatment as well as improves quality of life.

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