Percutaneous transhepatic drainage for malignant biliary obstruction

Percutaneous transhepatic drainage ( PTHD ) is an adjunct in the management of malignant biliary obstruction. It can be used for two purposes: as a palliative measure alone or as part of the preoperative preparation. This study assesses the efficacy of this technique. The charts of all patients undergoing PTHD were reviewed, and the data were collated according to the intent of catheterization. In the palliative group (18 patients), bilirubin levels fell from 20 +/- 1.8 to 10 +/- 1.9 mg/dl. PTHD complications developed in 14 (78%), the 1-month mortality was 56 per cent (10/18), and all of the patients have died (mean, 2.3 months). In the preoperative group (17 patients), bilirubin levels fell from 17 +/- 1.4 to 6 +/- 0.6 mg/dl, PTHD complications developed in three (18%), and postoperative complications occurred in five (30%). All patients in the preoperative group survived operation, 11 of 16 dying a mean of 4.5 months postoperatively. The five surviving patients have lived 2 to 25 months. The authors conclude that PTHD significantly lowers the serum bilirubin in both preoperative and palliative groups. In the preoperative group, its use is associated with low morbidity and may improve the patient's preoperative condition. In the palliative group, PTHD is associated with an appreciable morbidity that tempers the enthusiasm for its routine use in this circumstance.