Clinical Aspects of Nonsurgical Percutaneous Transhepatic Bile Drainage in Obstructive Lesions of the Extrahepatic Bile Ducts

Abstract

Percutaneous transhepatic cholangiography (PTC) with subsequent external bile drainage by nonsurgically established percutaneous transhepatic intubation of bile ducts was performed in 105 patients with obstructive jaundice. Recovery of liver function and improvement in the patients' general condition prior to radical or palliative surgery, nonsurgical palliation in advanced cases of malignancy as well as relief of postoperative leakage from a biliodigestive anastomosis are the indications for the bile drainage technique used in the present study. Clinical aspects such as optimal period of preoperative drainage, frequency of catheter dislodgement, and rate of complications such as cholangitis, bile leakage to the abdominal cavity and risk for peritoneal hemorrhage are discussed. Two deaths occurred within this series.

Efficacy of Preoperative Biliary Tract Decompression in Patients With Obstructive Jaundice

“…Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography (PTHC) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5\m=+-\7.6mg/dL and 14.9\m=+-\7.6mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5\m=+-\6.2mg/dL preoperatively in patients having PBD.…”

Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts

“…The incidence of cholangitis in patients with percutaneous transhepatic bile drainage was analyzed in a recent investigation [15]. Cholangitis was evident in about 25% of all patients with a drainage catheter during a period ranging from 1 week to 19 months.…”

“…Various techniques for external bile drainage by percutaneous transhepatic catheter intubation of the duct system have been described [5][6][7][8][9][10][11][12][13][14][15]. Further technical refinement has made it possible to manipulate percutaneous transhepatic catheters through the obstructing lesion into the distal segment of the common bile duct or the duodenum.…”

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

“…Reduction of hyperbilirubinemia usually occurs in 14 days [47,48]. This period must be used to control nutritional level, to correct an altered coagulation status, blood count, renal insufficiency and eventually to eradicate bile infection from multi-drug resistant bacteria.…”