Biliary and transhepatic drainage after liver resection

Posted by illinoismike @illinoismike, Oct 7 6:49pm

I was diagnosed with stage 4 colon cancer that had spread to my liver near the end of 2015.

Initially, surgery was not an option but chemotherapy worked and got it to the point that they were able to remove part of my liver, wait a few months, then remove another part of the liver as well as the original colon tumor. The surgeries took place in 2017.

Part of the surgery and aftermath was that my gall bladder was removed and the main bile duct was destroyed, so they had to put in an internal/external biliary drain. Then, about a year later, some sort of pocket started filling up near the liver, so they had to put in a transhepatic drain (this happened about 2 years ago).

I am curious to know if anyone else has had to deal with this. I have had two drainage tubes sticking out of my torso and draining into bags for two years now and am just not sure what the end game is or if there even is one. I have asked my interventional radiologist team and the goal at some point is to internalize the biliary drain, but no one seems to be able to tell me what the plan is for the transhepatic drain or what sort of timing can be expected or estimated.

I am quite happy to be cancer free and am, overall, doing well, but it's really starting to annoy me that I can't go swimming or sleep on one side of my body or just move freely without risking my tubes and drainage bags getting in the way.

Maybe there's nothing that can be done other than continue to wait until it resolves on its own, but I keep hoping there is some intervention that can be done to solve this.

Hi @illinoismike, welcome to Mayo Clinic Connect and the Colorectal Cancer group. It certainly is a paradox. One is grateful to be alive and that treatment worked, and then one feels ungrateful to be put out by consequences of the successful treatment. Living with drainage tubes and bags permanently is certainly do-able, but one certainly wants to explore options.

I'm tagging fellow members @tinad @tearose @tressa @candywocrn @rosemarya and @jolinda who maybe have experience with biliary and/or transhepatic drains.

Mike, what will indicate that the biliary drain can be internalized? I can understand your frustration in not knowing what the game plan is for the transhepatic drain. When you ask questions about the expectations for the transhepatic drain (which I'm sure you do), what response do you get?

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Hi Colleen,

Thanks!

My understanding is that we can't internalize the biliary drain until/unless the other drain is resolved. I'm not sure if I'm not asking the right questions or my docs are being vague mainly because they truly don't have a good way to predict what will happen and don't want to risk dealing in probabilities. I hope it doesn't sound like I'm criticizing them, they're amazing and I trust them, I'm just getting frustrated with the state of my body and trying to find additional sources of information.

Matters are also complicated by the fact that, they have told me that when they use dye and live imaging to check on things, there is evidence that the two drains have a fistula or some sort of communication going on. I don't know how common that is or what would need to happen in order to allow the biliary drain to finally get internalized but I think the communication issue is what is the main blocker right now.

I don't even have a good idea of how many cases like mine there are, but I suspect not very many. The last time I googled the 5-year survival rates for stage 4 colon cancer, it was a pretty grim number; something like 15%. I got cancer relatively young (diagnosed at age 48) and I suspect there just aren't enough similar cases to say something like "oh, well, what you do in this case is X, Y and Z and then that normally results in A, B and C…"

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I was diagnosed with colon cancer stage 4 and it had spread to the liver ( in January 2019 ) in March I had surgery, they did everything in one session. They took out part of my Colon, a liver resection, part of my pancreas (wipple manoeuvre ? ) and removed my gallbladder. I had a drain sticking out of my side for two weeks and than it was removed. I was quite sick but recovered well, was discharged from the hospital after 2weeks. After 8 weeks at home I started to feel stronger, than in June I started Chemo treatment

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To continue ,my chemo meds was fluorouracil 4000 mgr. via infusion,( had a Porta-cath.)Every other week. Had as side effects bad diahrea , by the 7th treatment , I was very sick, constant diarrhea and vomitting and was admitted to the hospital where I was for 4 weeks before I had recovered. No more Chemo treatments. I gradually got my strength back. Have every 3 rd month a bloodtest and a CT Scan of chest abdomen and pelvis ands far all tests were negative. I live a normal independent life again. I live by myself . I am now 81 yrs .And in remission.

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Oh my gosh! I had a biliary drain due to complications from a liver resection as well. I also have stage 4 cancer diagnosed as stage 2 in 2015 and progressed to stage 4 in 2017. I’ve had multiple surgeries and have had complications from almost all of them. My drain was in for 7 months and I found it so difficult. I honestly can’t imagine having one for that length of time. I hope they can resolve this issue for you!

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