Antegrade cholangiostomy: analysis and prevention of complications

Abstract

Aim. To analyze complications of percutaneous transhepatic cholangiostomy depending on biliary obstruction level and drainage type.Material and methods. Percutaneous transhepatic biliary drainage was carried out in 974 patients with mechanical jaundice of different genesis. External drainage was predominantly performed for distal obstruction, external-internal suprapapillary – for proximal obstruction. Strictures of biliodigestive anastomosis were managed using percutaneous balloon dilatation and long-term external-internal drainage.Results. Overall morbility was 19.1%. Significant relationship between morbidity and obstruction level, drainage type and tubes quantity was detected. Drainage tube dislocation was the most common drainage-related complication both in proximal and distal obstruction. External-internal transpapillary drainage was followed by suppurative cholangitis and acute pancreatitis in 81.5% of cases. External-internal suprapapillary drainage was accompanied by acute cholangitis in 17.1% of patients and was determined by disconnection of subsegmental ducts that required additional drainage tubes placement. In most cases, complications were corrected by minimally invasive surgery and nonsurgical treatment. Overall mortality was 1.3% (0.3% in cases of distal obstruction and 1.8% in cases of proximal obstruction).Conclusion. Percutaneous transhepatic biliary drainage is a routine non-traumatic method of biliary decompression that may be successfully used irrespective to obstruction level and cause of jaundice. External-internal suprapapillary drainage is preferable for proximal biliary obstruction while external-internal transpapillary drainage should be avoided.