Complications of percutaneous biliary drainage: benign vs malignant diseases

Percutaneous transhepatic biliary drainage is used to treat a variety of benign and malignant biliary diseases. Although several investigators have reported on the number of complications associated with the use of this procedure in malignant disease, none has determined specifically the number associated with its use in benign disease. Differences in the number of procedure-related complications and deaths were examined in 206 patients with benign or malignant biliary diseases who underwent percutaneous transhepatic biliary drainage at the Toronto General Hospital during a 40-month period. Of these, 54 had benign and 152 had malignant biliary diseases. The prevalences of procedure-related major complications and deaths were 2% and 0%, respectively, in the benign group vs 7% and 3%, respectively, in the malignant group. These differences can be attributed to the shorter periods of drainage required and the generally better health of patients in the benign group. These findings suggest that percutaneous transhepatic biliary drainage can be performed with substantially fewer complications in patients with benign biliary diseases compared to those with cancer. Previously reported data on complications were derived from patient populations with preponderantly malignant obstructions and cannot be extrapolated to patients with benign diseases.