Septic complications of percutaneous transhepatic biliary drainage. Evaluation of a new closed drainage system.

In a consecutive study of 49 patients with obstructive jaundice who underwent preoperative percutaneous transhepatic drainage, the incidence of bacteria in bile at the time of insertion of the drainage catheter was 29 percent. Patients drained with a conventional open drainage system showed an increase to 100 percent positive cultures after 20 days drainage. In this group, there was also a high incidence of episodes of bacteremia preoperatively and postoperatively and a high incidence of positive wound cultures. An antiseptic barrier incorporated into the drainage system reduced the incidence of positive bile cultures during the drainage period although this did not afford a significant reduction in bacteremic episodes and positive wound cultures. Using a new closed drainage system, the acquisition of environmental organisms to the bile was eliminated which allowed a significant reduction in septic complications both preoperatively and postoperatively. This new closed drainage system increased the value of preoperative decompression of the obstructed biliary tree by preventing exogenous bacterial contamination and reducing associated septic episodes.