Percutaneous transhepatic biliary drainage: alternatives in left hepatic duct obstruction.

The left-lobe subxiphoid approach has been the standard way to drain left hepatic duct occlusion. A new, right-side biliary drainage approach is described. Five patients, among 25 patients with bilateral biliary obstruction, were treated by an internal-internal drainage system. Three types of internal-internal drainage techniques are described: internal-internal luminal, type 1; internal-internal luminal, type 2; and internal-internal transductal, type 3. All 5 patients succeeded in biliary drainage. The internal-internal biliary drainage technique, performed from the right-side approach, is effective, avoids additional liver puncture and tract dilatation, and allows the combination of several biliary drainage techniques, adding greatly to the flexibility when treating intrahepatic obstruction. No complications were observed in our small series but special precaution should be taken with the transductal technique due to the possibility of bleeding.