Biliary drainage by ultrasound-guided puncture of the left hepatic duct.

Percutaneous transhepatic biliary drainage under ultrasonic guidance was performed in 38 patients with obstructive jaundice due to malignancy (49 intubations). The method was used for palliation in 33 patients and for pre-operative drainage because of cholangitis in five patients. Puncture of the left lobar ducts was the method of choice (35 patients). Only in cases of poor visualisation of the left biliary ducts was right-sided drainage performed (three patients). Combined left- and right-sided drainage was necessary in nine patients. All attempts with ultrasound-guided punctures were successful. There were no complications related to the punctures. Delayed complications were cholangitis (10 patients) and bleeding (one patient). The advantages of the method compared with conventional percutaneous transhepatic biliary drainage and the advantages of the left liver lobe drainage are outlined.