Avoidance of transhepatic drainage prior to hepaticojejunostomy for obstruction of the biliary tract

We retrospectively reviewed the course of 14 consecutive patients with symptomatic hepatic duct bifurcation obstruction of the biliary tract because of unresectable non-Klatskin malignant disease to clarify issues of diagnostic and therapeutic strategy. All patients were symptomatic with pruritus and were expected to survive three months or more. Ten patients underwent percutaneous transhepatic cholangiography preoperatively. In no instance did the study influence operative decision making, and complications included septic shock in two patients. Decompression of the biliary tract in one patient made the duct technically inadequate for internal drainage. The remaining 13 patients underwent surgical drainage of the biliary tree. Ten had peripheral hepaticojejunostomies, which offers the best palliation of symptomatic obstruction of the biliary tract due to unresectable malignant disease at the hepatic duct bifurcation. Percutaneous transhepatic cholangiographic drainage should not be used for diagnostic studies prior to hepaticojejunostomy for malignant obstruction as it interferes with surgical drainage.