Crisscross-Configured Dual Stent Placement for Trisectoral Drainage in Patients with Advanced Biliary Hilar Malignancies

PURPOSE: To evaluate technical success and clinical efficacy of crisscross-con figured dual biliary stent implantation in patients with a biliary hilar tumor extending beyond the segmental ducts. MATERIALS AND METHODS: Between January 2002 and December 2006, two metallic stents were placed crossing each other in a hepatic hilum in 42 patients. One stent was placed between one right sectoral duct and the left hepatic duct and the other was placed between another right sectoral duct and the common bile duct. The patients ranged in age from 36 to 83 years (mean, 63.3 y) and included 26 men and 16 women. Technical success, clinical success, complications, and long-term results were analyzed by retrospective review. RESULTS: Stent placement was performed through two right accesses (n = 30), one right and one left access (n = 3), or two right accesses and one left access (n = 6). Successful "trisectoral" drainage was obtained with two stents in 41 patients (98%). In one case of initial technical failure, an additional stent was needed to connect the two previously placed stents. Clinical success was obtained in 34 of the remaining 36 patients (92%). No procedure-related major complication was observed. The median primary stent patency time was 187 days and the median patient survival time was 247 days. CONCLUSIONS: Crisscross-configured dual stent implantation is a feasible, safe, and effective method to maximize hepatic drainage with a minimal number of stents in patients with advanced biliary hilar malignancy.