PURPOSE: To evaluate the feasibility and outcome of percutaneous biliary neo-anastomosis (PBNA) by means of fluoroscopy-guided enteral/biliary puncture, followed by temporary percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: Four patients (25% female, mean age 56 years) were referred for PBNA (bilio-entero-neo-anastomosis, n = 3
bilio-biliary-neo-anastomosis, n = 1) between 2007 and 2021. They presented with right posterior bile duct exclusion and bile leakage after major liver or pancreatic surgery, or hemiliver transplant. After puncture of the excluded/leaking bile duct, neo-anastomosis was performed under fluoroscopic guidance using the back end of a 0.018" guidewire (n = 3) or a vascular reentry device (n = 1). PTBDs were inserted to assure PBNA healing. RESULTS: Technical success rate was 100%. No complications occurred. All PTBDs were removed (median = 65 days). During a median follow-up of 2.8 years, two patients died due to unrelated causes. No subsequent bile leakages or re-occlusions were observed. CONCLUSION: In conclusion, PBNA is feasible and safe, and offers long-term biliary patency even in liver-transplanted patients.