Complications of left and right sided percutaneous transhepatic biliary drainage

Abstract

Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed either via right or left-ductal approach, on the basis of status of primary confluence, secondary confluence and atrophy of liver parenchyma. Our study compares the complications of two approaches in malignant obstruction. The objectives of this study was to assess and compare complications of PTBD.Methods: This study was a prospective hospital based study performed for a period of 2 years from 2016 to 2018.PTBD was performed either via right in 16 patients or left-ductal approach in 15 patients, on the basis of status of primary biliary confluence and atrophy of liver parenchyma.Results: Both minor and major complications were more common in right-sided approach as compared to left-sided approach with most common major and minor complication being cholangitis (16.12%) and fever (12.9%) respectively.Conclusions: PTBD is an excellent palliative procedure to drain the bile ducts in malignant obstruction. Although complications of PTBD are more common in right sided approach but results are statistically insignificant.

Clinical outcomes of percutaneous transhepatic biliary drainage at different Couinaud's hepatic entry segments for treating obstructive jaundice

“…In contrast, a study including 50 PTBD patients reports no significant difference in quality of life, success rates, or complications between the left and right approaches ( 11 ). Other studies investigating complications after PTBD report a slightly higher rate of hemobilia following the left approach ( 12 ) and more cases of cholangitis and fever with the right approach ( 13 ), but the differences were not statistically significant in either study. While one study of 36 PTBD procedures observed no differences in efficacy or safety between the 2 approaches( 14 ), our previous study including 446 PTBD patients showed that the left approach had better clinical outcomes and fewer complications ( 15 ).…”

“…We observed significantly lower complication rates with PTBD entry at segment 2/3 (9.4%) and 5/6 (6.4%) than at segment 7/8 (42.6%). Rafiq et al observed more complications with right-sided (subcostal or intercostal) than left-sided (sub-xiphoid) PTBD, although the differences were statistically insignificant, possibly due to their small cohort size ( n = 31) ( 13 ). The similar result in our much larger cohort not only confirms that fewer complications occur in left-side PTBD but also shows that the high complication rate for right-sided PTBD is due to entry at segment 7/8.…”

“…Catheters may become malpositioned in response to respiratory movements and can gradually be pulled out of the liver. One study reports that PTBD catheter dislodgement occurred only on the right side, noting that its displacement was due to continuous motion of the catheter in the intercostal space during respiration ( 13 ). Another study also reports a higher incidence of catheter dislodgement in right-sided PTBD, and the authors suggest that the high incidence may be due to the small volume of the intercostal space and greater movement of the catheter within the liver during respiration, leading to displacement of the internal section of the catheter ( 11 ).…”