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Percutaneous transhepatic drainage. Risks and benefits.

E C Stambuk, H A Pitt, S O Pais

    Archives of Surgery (Chicago, Ill. : 1960)
    |December 1, 1983
    PubMed
    Summary

    Percutaneous transhepatic biliary drainage (PTD) poses risks, especially for palliative patients with high bilirubin levels. PTD may be beneficial for severe pruritus, but risks often outweigh benefits in advanced cancers.

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    Area of Science:

    • Interventional Radiology
    • Hepatobiliary Surgery

    Background:

    • Percutaneous transhepatic biliary drainage (PTD) is a procedure to decompress the biliary system.
    • Patient selection is crucial for optimizing PTD outcomes.

    Purpose of the Study:

    • To evaluate the risks and benefits of PTD in patients undergoing palliative or preoperative biliary drainage.
    • To identify patient subgroups at higher risk for complications and mortality.

    Main Methods:

    • Retrospective analysis of 44 patients divided into palliative (n=22) and preoperative (n=22) groups.
    • Complication rates, mortality, and liver function test changes were assessed.

    Main Results:

    • Major complications occurred in 23% of patients, with higher rates in the palliative group (36% vs. 9%).

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  • Thirty-day mortality was significantly higher in the palliative group (27% vs. 0%), particularly in patients with bilirubin > 20 mg/dL.
  • Liver function improved in 85% of patients; 95% of preoperative patients survived surgery.

    • Conclusions:

    • PTD risks may outweigh benefits in palliative patients with advanced malignancy and high bilirubin levels (>20 mg/dL).
    • PTD can be justified for incapacitating pruritus, even in high-risk patients.
    • Preoperative PTD is recommended for patients with bilirubin levels > 10 mg/dL pending further trials.