Abstract
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Purpose: We performed a retrospective analysis of clinical outcomes in patients with bile leaks demonstrated by hepatobiliary scintigraphy (HBS). An unmet clinical need is a standardized method of biliary leak categorization based on qualitative findings of HBS. A thorough understanding of clinical outcomes in patients with leaks of variable size and histories can provide valuable data in directing the need for further surgical care, drainage, and diverting stents versus strict medical or expectant management. Materials and Methods: We qualitatively categorize hepatobiliary scintigraphy (HBS) results and associated interventions and outcomes in a retrospective analysis of 550 patients with suspected bile leaks acquired over 6 years. Outcomes are based on correlative imaging, subsequent interventions, and chart review. HBS were assessed for presence, size (small, medium, large), and location (contained, intra-peritoneal, extra-peritoneal, limited to drainage catheter). Root causes include: cholecystectomy, liver transplant, liver resection, and trauma.HBS were performed with 8 mCi of Tc 99m mebrofenin. Imaging was performed initially and repeated at 24 hours. Leak size was characterized based on scan findings, correlative imaging, and recorded external biliary drainage.
Results: Provide quantitative results and a statistical summary. For instance, results will include the number of patients examined, associated risk factors for biliary leak, size, distribution and specific interventions aimed towards resolution.Additionally, a numerical summary of patient outcomes will be provided with regards to leaks and correlations with cause and size.
Conclusions: Detection of biliary leaks with hepatobiliary scintigraphy in the post-operative or post-traumatic period requires knowledge of the surgical procedure performed, anatomic variation and technique optimization. Evaluation of the causative factors which contribute to the largest biliary leaks and collections as well as subsequent assessment of the most effective interventional and diagnostic techniques to address said leaks, may aid surgeons and clinicians alike in reducing this risk, the timeline to leak resolution and the patient morbidity that follows. CLINICAL RELEVANCE/APPLICATION Establish guidelines for medical versus surgical intervention and correction of suspected biliary leaks with regards to the size of leak and initial inciting factors.