Preoperative percutaneous transhepatic drainage: use or abuse. A clinical review

The benefit of preoperative percutaneous transhepatic biliary drainage in patients with obstructive jaundice was reviewed in the literature from 1974 to July 1984. The role of preoperative drainage cannot be definitively assessed. Significant reduction of morbidity and mortality has been reported in some non-controlled studies; however, no benefit of preoperative "external" drainage was found in the only two reported randomized studies. At the present time external preoperative drainage cannot be advised routinely and the hazards of this technique and effect of bile losses may outweigh the benefits. The benefits of preoperative internal drainage without bile loss and closing of the enterohepatic cycle needs to be evaluated both percutaneously and endoscopically. Criteria, developed after specific identification of high risk patients, should be used to select patients for biliary drainage and to evaluate results of drainage studies. The clinical well-accepted drainage period of 2-4 weeks is controversial and the optimum period of drainage also requires further evaluation. The percutaneous approach carries significant morbidity and mortality.