The role of percutaneous transhepatic internal biliary drainage in preoperative patients

Routine percutaneous transhepatic drainage (PTD) has been recommended for minimizing morbidity after operations for obstructive jaundice. This approach assumes that early complications of PTD are rare or insignificant. It has also been suggested that internal (transsphincteric) drainage is superior to external drainage. To assess its safety, a consecutive series of 18 patients in whom PTD was performed prior to definitive operations for obstructive jaundice was reviewed. Internal biliary drainage was attempted in every instance. The biliary system was successfully cannulated in 100 per cent and the drainage catheter was passed into the duodenum in 16 patients (88%). Five patients (28%) had serious complications of PTD requiring emergency operations; three died. Complications after internal PTD were no rarer or less serious than those after transhepatic cholangiography without drainage. We recommend early surgical exploration once the site of complete biliary obstruction is demonstrated by cholangiography.