PURPOSE To investigate the effectiveness of percutaneous approaches to treat bile leak and to propose an anatomical classification of biliary fistula to guide the most appropriate percutaneous approach. MATERIALS AND METHODS Fifty-six patients with bile leakage after hepatobiliary surgery were included. Based on preoperative images and postoperative fistulogram images, three categories of bile leakage were defined. Every category was treated with non-surgical approaches (internal-external percutaneous drainage, percutaneous/endoscopic biliodigestive anastomosis with rendez-vous technique and biliodigestive percutaneous anastomosis with totally radiologic rendez-vous). RESULTS In 44/56 (78%) patients, anatomical conformation was "direct communication" (bile ducts upstream from the leak present a direct communication with downstream ducts) and their treatment was conventional percutaneous drainage. In 5/56 (9%), anatomical conformation was "indirect communication" (bile ducts upstream from the leak communicate with downstream ducts through a bile collection) and treatment was percutaneous/endoscopic rendez-vous technique. In 7/56 (12%), anatomical conformation was "no communication" (ducts upstream from the leak are completely excluded from ducts downstream) and treatment was totally radiologic rendez-vous. In 54/56 (96%) during the follow-up, cholangiography revealed complete resolution of the leak without residual stenosis and drains were removed. Complications occurred in 12/56 (21%). Procedure-related mortality was 0%. Ten patients, after > 6 months from resolution of their fistula and drain removal, died due to cancer recurrence. Currently, 44/56 patients (77%) at long-term follow-up (> 12 months) are alive, without bile leak. CONCLUSION Our classification helps to choose the most proper percutaneous approach in all kinds of bile leakage, even in severe cases; these are safe techniques with a high success rate.

中文翻译：

---

肝胆胰外科手术后胆漏：分类系统，指导正确的经皮治疗。

目的探讨经皮入路治疗胆漏的有效性，并提出胆道瘘的解剖分类，以指导最合适的经皮入路。材料与方法纳入五十六例肝胆外科手术后胆漏患者。根据术前图像和术后瘘管图像，定义了三类胆漏。每种类别均采用非手术方法治疗（内外经皮引流，采用结扎技术的经皮/内镜胆道消化道吻合术和经全放射性结扎的胆囊消化道经皮吻合术）。结果在44/56（78％）患者中，解剖学构象是“直接交流” （泄漏上游的胆管与下游导管直接连通），其治疗方法为常规经皮引流。在5/56（9％）的患者中，解剖结构是“间接连通的”（泄漏上游的胆管通过胆汁收集与下游的导管连通），治疗方法是经皮/内窥镜交会技术。在7/56（12％）的情况下，解剖学构型为“无联系”（泄漏上游的导管完全被下游导管排除），并且治疗完全是放射会合。在随访期间，在54/56（96％）的患者中，胆管造影显示完全解决了渗漏，而没有残余的狭窄，并清除了引流管。并发症发生率为12/56（21％）。手术相关死亡率为0％。十名患者，> 瘘管和引流管切除后六个月，因癌症复发而死亡。目前，长期随访（> 12个月）的44/56例患者（77％）还活着，没有胆汁渗漏。结论我们的分类有助于在各种胆漏中选择最合适的经皮入路，即使在严重的情况下也是如此。这些都是安全的技术，成功率很高。