A Retrospective Analysis Comparing Technical Difficulty and Safety between Right and Left-sided Percutaneous...

Area of Science:

• Interventional Radiology
• Hepatobiliary Medicine

Background:

• Percutaneous transhepatic biliary drainage (PTBD) is a crucial intervention for biliary obstruction.
• Nondilated bile ducts present unique challenges for PTBD procedures.
• Comparing right-sided (R-PTBD) and left-sided (L-PTBD) approaches is essential for optimizing patient outcomes.

Purpose of the Study:

• To compare the technical difficulty and safety of R-PTBD versus L-PTBD.
• To evaluate key procedural metrics including needle punctures, success rates, and complication profiles.
• To determine the preferred approach for PTBD in patients with nondilated bile ducts.

Main Methods:

• A comparative study involving 42 patients undergoing PTBD for nondilated bile ducts.
• Patients were divided into R-PTBD (n=22) and L-PTBD (n=20) groups.
• Evaluated parameters included needle punctures, successful biliary access, technical success, catheter placement difficulty, fluoroscopic time, procedure time, and complications.

Main Results:

• The R-PTBD group demonstrated significantly fewer needle punctures (p=0.004) and shorter procedure durations (p=0.021) compared to L-PTBD.
• While R-PTBD showed higher rates of successful biliary puncture and technical success, these did not reach statistical significance (p>0.05).
• Catheter placement difficulty was more frequent in the L-PTBD group, with comparable overall and hemorrhagic complication rates between both approaches.

Conclusions:

• Right-sided PTBD is associated with reduced technical difficulty compared to the left-sided approach in patients with nondilated bile ducts.
• R-PTBD may be favored when both approaches are technically feasible due to potentially simpler execution.
• Further research could explore factors influencing approach selection and long-term outcomes.