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Related Experiment Videos

Can we do away with PTBD?

R D Bapat1, N N Rege, R S Koti

  • 1Department of Gastroenterology Surgical Services, Seth G. S. Medical College, Bombay, India.

HPB Surgery : a World Journal of Hepatic, Pancreatic and Biliary Surgery
|January 1, 1995
PubMed
Summary
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Percutaneous transhepatic biliary drainage (PTBD) did not improve outcomes in surgical jaundice patients and increased sepsis risk. Tinospora cordifolia (TC) supplementation, with or without PTBD, enhanced immune function and reduced mortality.

Area of Science:

  • Hepatobiliary Surgery
  • Immunology
  • Surgical Jaundice Management

Background:

  • Surgical jaundice patients face high sepsis risk and poor outcomes, often managed with Percutaneous Transhepatic Biliary Drainage (PTBD).
  • Previous studies suggest Tinospora cordifolia (TC) possesses immunotherapeutic properties.
  • The necessity and efficacy of PTBD in this patient population warrant further investigation.

Purpose of the Study:

  • To evaluate the impact of PTBD on surgical jaundice outcomes, focusing on sepsis incidence and host defense mechanisms.
  • To assess the potential immunomodulatory and therapeutic effects of Tinospora cordifolia (TC) in patients with surgical jaundice, with or without PTBD.

Main Methods:

  • A study involving four groups of patients: surgery without PTBD, surgery after PTBD, PTBD with TC, and no PTBD with TC.

Related Experiment Videos

  • Serial monitoring of bilirubin levels, antipyrine half-life, and polymorphonuclear leukocyte (PMN) functions (phagocytosis and intracellular killing).
  • Comparison of mortality rates across the different treatment groups.

    • Main Results:

    • PTBD did not significantly improve liver metabolic capacity or reduce mortality; in fact, mortality was higher in the PTBD group.
    • Bilirubin levels decreased with PTBD, but PMN functions remained suppressed, indicating persistent immunosuppression.
    • Tinospora cordifolia (TC) administration, regardless of PTBD, significantly improved PMN functions and markedly reduced preoperative and postoperative mortality.

    Conclusions:

    • Percutaneous Transhepatic Biliary Drainage (PTBD) may be unwarranted in surgical jaundice management due to lack of demonstrated benefit and potential increased sepsis risk.
    • Host defense mechanisms, particularly PMN functions, are critical determinants of prognosis in surgical jaundice.
    • Tinospora cordifolia (TC) shows promise as an immunotherapeutic agent, improving host defenses and patient outcomes in surgical jaundice.