Percutaneous transhepatic biliary drainage for obstructive jaundice.

Percutaneous Transhepatic Biliary Drainage (PTBD) is a new but already well-recognised non-surgical method of overcoming extrahepatic biliary obstruction. It can be used as a temporary measure to improve the patient's general condition prior to high-risk operative surgery. It provides time for further investigation and, if the patient has an advanced malignancy, he can be offered a long-term PTBD as the definitive palliative treatment. Thus surgery, with its high rates of mortality and morbidity in such patients, is avoided. In ten cases preoperative PTBD reduced serum bilirubin (P less than 0.01), serum alkaline phosphatase (P less than 0.05), and lactic dehydrogenase (P less than 0.01) levels after 12 +/- 5 days, and resulted in minimal operative morbidity and mortality. Twelve patients with advanced malignancy had long term PTBD and three experienced good palliation for 12-14 months.