Results of percutaneous transhepatic biliary drainage

Romualdas Riauka Master's thesis „Results of percutaneous transhepatic biliary drainage“ / Scientific supervisor prof. G. Barauskas, MD, PhD; Lithuanian University of Health Sciences, Faculty of Medicine, Department of Surgery - Kaunas Percutaneous transhepatic biliary drainage (PTBD) acts as an alternative way to achieve biliary decompression in patients with obstructive jaundice, when endoscopic drainage is unavailabe. This procedure can reduce high serum bilirubin levels, this way achieving better liver function, reducing side effects of jaundice and hiperbilirubinaemia and allowing patients to receive further treatment. Aim of this master's thesis was to evaluate the drainage results of patients, who received PTBD in the Department of Surgery of Hospital of Lithuanian University of Health Sciences between year 2014 and 2015. Objectives were: to analyze main indications to perform PTBD, to evaluate procedure's technical success rate and laboratory outcomes, to asses main additional interval procedures and drainage related complications and to analyze main in-hospital mortality causes. Retrospective review of patients with successful or unsuccessful PTBD attempts between year 2014 and 2015 was performed. Patients were reviewed for biliary obstruction causes, laboratory tests prior the procedure, complications related to percutaneous drainage, outcomes (laboratory tests at the time of discharge and additional interval procedures), causes and rate of mortality. Malignant diseases were present in 91,5 % of the patients. Periampullary tumors (33,3%) and liver metastases (32,6%) were main cause of biliary obstruction. PTBD procedure was successful in 123 out of 129 patients (technical success rate - 95,3%). Values of total serum bilirubin, gamma-glutamyltransferase, alkaline phosphatase, aspartate transaminase and alanine transaminase were statistically significantly lower after PTBD, compared to values prior PTBD. There were 71 transhepatic biliary stenting procedures (81,6%) out of 87 additional interval procedures. Drainage catheter discolation occured 34 times out of 49 (69,4%). Out of 38 deceased patients, 20 patients (52,6%) died because of cholangitis and sepsis. Main indication to perform PTBD was obstructive jaundice caused by periampullary tumors and liver metastases. Procedures technical succes rate was 95,3%. PTBD statistically significantly reduced values of total serum bilirubin, gamma-glutamyltransferase, alkaline phosphatase, aspartate transaminase and alanine transaminase, compared to values prior PTBD. Most common additional interval procedure after PTBD was percutaneous transhepatic biliary stenting. Main occuring complication was dislocation of drainage catheter. Most common cause of death was cholangitis and sepsis