Role of interventional radiology in the management of posthepatectomy collections

Purpose To evaluate the role of image-guided percutaneous drainage in the management of post-hepatectomy perihepatic fluid collections. Materials and Methods An institutional database was used to retrospectively identify patients who underwent drainage for a post-hepatectomy peri-hepatic collection between 2007 and 2011. Medical records were reviewed to determine patient demographics, indications for surgery, imaging documentation of fluid collection(s), drainage procedure and follow-up. Technical success was defined as the successful placement of a drainage catheter within the fluid collection. Primary clinical success was defined as resolution of fluid collection by placement of drainage catheter. Secondary clinical success was defined as resolution of the peri-hepatic fluid collection after secondary manipulation of drainage catheter not requiring surgery. Results Between 2007 and 2011, 20 patients (M:F=12:8) with a mean age of 67 years (range: 49-80 years), underwent drainage of a post-hepatectomy peri-hepatic fluid collection. Sixteen patients (80%) underwent computed tomography guided drainage and 4 (20%) underwent ultrasound guided drainage. The mean collection size was 8.3 cm (range 2.2 cm -18 cm) and mean duration of catheter drainage was 26.5 days, (range 25- 89 days). Technical success was 100%, primary clinical success rate was 75 % (15/20) and the secondary clinical success rate was 20% (4/20) with an overall clinical success rate of 95%. One patient required surgical management of the collection for continuous high biliary output following successful catheter placement. None of the patients had procedure related complications. Conclusion Image-guided percutaneous catheter drainage of post-hepatectomy fluid collections is safe and effective procedure that is associated with high clinical success. Percutaneous drainage should be considered for the management of post-hepatectomy peri-hepatic collections.