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Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice--a prospective randomised
1Dept. of Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
Patients with obstructive jaundice undergoing surgical procedures have a significant risk of morbidity and mortality. The role of preoperative percutaneous transhepatic biliary drainage (PTBD) was evaluated in a randomized trial.
Methods:
A total of 40 patients were assigned to either preoperative PTBD (n = 20), or surgery alone (n = 20). PTBD was performed under ultrasound guidance. There were no major complications related to the procedure.
Results:
Ultrasound guided drainage was a successful and safe method of preoperative biliary decompression. There was a marked relief from pruritus and significant reduction of hyperbilirubinaemia from a mean of 386.48 mumol/L to 116.10 mumol/L (p < 0.001). Mean duration of drainage was 42.5 days. Postoperative complications occurred in five patients in PTBD group (25%) compared to 11 patients (55%) in the control group. One death (5%) occurred in PTBD group compared to four deaths (20%) in the control group (significant at 5% level with probability 0.2).
Conclusions:
Ultrasound guided drainage is a useful preoperative supportive measure in preparing deeply jaundiced patients for surgery and permits hepatic function to return to a near normal state preoperatively. The improved results in our study were due to longer duration of drainage.