Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice--a prospective randomised study.
BACKGROUND
Patients with obstructive jaundice undergoing surgical procedures have a significant risk of morbidity and mortality. The role of preoperative percutaneous transhepatic biliary drainage (PTBD) was evaluated in a randomized trial.


METHODS
A total of 40 patients were assigned to either preoperative PTBD (n = 20), or surgery alone (n = 20). PTBD was performed under ultrasound guidance. There were no major complications related to the procedure.


RESULTS
Ultrasound guided drainage was a successful and safe method of preoperative biliary decompression. There was a marked relief from pruritus and significant reduction of hyperbilirubinaemia from a mean of 386.48 mumol/L to 116.10 mumol/L (p < 0.001). Mean duration of drainage was 42.5 days. Postoperative complications occurred in five patients in PTBD group (25%) compared to 11 patients (55%) in the control group. One death (5%) occurred in PTBD group compared to four deaths (20%) in the control group (significant at 5% level with probability 0.2).


CONCLUSIONS
Ultrasound guided drainage is a useful preoperative supportive measure in preparing deeply jaundiced patients for surgery and permits hepatic function to return to a near normal state preoperatively. The improved results in our study were due to longer duration of drainage.
Wig
J D
JD
Dept. of Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Kumar
H
H
Suri
S
S
Gupta
N M
NM
D000328:Adult; D000368:Aged; D002779:Cholestasis / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D015996:Survival Rate; D016896:Treatment Outcome