Percutaneous transhepatic biliary decompression. Results and complications in 30 patients.

The palliative management of malignant obstruction of the biliary tree continues to challenge clinicians. The technique of PTBD has become increasingly popular to decompress the obstructed biliary system. Our initial experience with 30 consecutive patients treated with PTBD has been retrospectively reviewed. Internal drainage and effective biliary decompression was achieved in 90 and 86 percent of patients, respectively. Complications developed in 7 of 11 patients with long-term PTBD. Two patients died from septic complications. Three of 10 patients had major complications associated with preoperative PTBD. The remaining seven patients had permanent PTBD but did not derive any clinical improvement. Postoperative mortality after palliative procedures for malignant biliary obstruction is most often associated with carcinomatosis and advanced disease. Palliative biliary bypass provides effective palliation until the patient's death. There are groups of patients with an expected survival of more than 3 months and technically bypassable biliary obstruction who are best palliated by biliary enteric anastomosis. Patients with advanced disease are not candidates for either form of treatment. In patients with lesions not suitable for surgical bypass, PTBD remains a useful alternative.