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Risks and Benefits

Edgar C. Stambuk, MD; Henry A. Pitt, MD; S. Osher Pais, MD; Linda L. Mann, RNP; Juan F. Lois, MD; Antoinette S. Gomes, MD

Arch Surg. 1983;118(12):1388-1394.

Abstract
• We evaluated the risks and benefits of percutaneous transhepatic biliary drainage (PTD) in 44 patients. Patients were divided into two groups, palliative and preoperative, each of which had 22 patients. Major complications included bacteremia, hemobilia, and liver abscess and occurred in ten patients (23%). A liver abscess along the catheter tract may have contributed to the death of one patient with an advanced malignant neoplasm. Major complications were more likely to develop in palliative-group patients (36% v 9%) and those patients were more likely to die within 30 days of the procedure (27% v 0%). Four (57%) of seven palliative-group patients and none of six preoperative-group patients with pre-PTD bilirubin levels higher than 20 mg/dL died within 30 days after PTD. Liver function test results improved within seven days in approximately 85% of the patients. Twenty-one patients (95%) in the preoperative group survived surgery. We concluded that the risk of PTD may outweigh the benefit in the subset of patients with advanced malignant neoplasms and a bilirubin level higher than 20 mg/dL. Even then, however, PTD may be justified if pruritus is incapacitating. Pending results of further randomized trials, we have continued performing PTD preoperatively in patients whose bilirubin levels exceed 10 mg/dL.

(Arch Surg 1983;118:1388-1394)

Author Affiliations
From the Departments of Radiology (Drs Stambuk, Pais, Gomes, and Lois) and Surgery (Dr Pitt and Ms Mann), UCLA School of Medicine.

Footnotes
Accepted for publication July 26, 1983.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Rancho Mirage, Calif, Jan 15, 1983.

Reprint requests to 77-130 Center for the Health Sciences, UCLA School of Medicine, Los Angeles, CA 90024 (Dr Pitt).