Percutaneous Transhepatic Extra-Anatomical Biliodigestive Anastomosis of an Excluded Accessory Right Posterior Bile Duct after Pancreaticoduodenectomy

Abstract Biliary complications, such as leaks and obstructions, pose significant postoperative challenges, especially when endoscopic access is unfeasible. This case report highlights the exclusive use of a percutaneous technique to establish an extra-anatomical biliodigestive anastomosis for a persistent biliary leak from an excluded right posterior bile duct following pancreaticoduodenectomy. A transhepatic approach was employed, redirecting bile flow via an internal-external drain and later stenting, achieving symptom resolution without surgical reintervention. This technique might be a viable alternative for managing complex biliary leaks, leveraging percutaneous methods to restore continuity. Long-term follow-up confirmed its success, suggesting further investigation into its safety and efficacy.