Effect of percutaneous transhepatic drainage upon liver function and postoperative mortality.

The results of the use of percutaneous transhepatic drainage in 109 patients between 1968 and 1980 were analyzed. The serum concentration of bilirubin decreased during the three week drainage period but not to normal values and more slowly than would be expected from normal hepatic bilirubin elimination, in site of adequate drained bile volumes. This decrease was most pronounced during the first week of drainage and in patients with high predrainage bilirubin levels. During refeeding of bile into the intestine, hepatic bilirubin excretion seemed to increase, possibly as a result of higher bile acid excretion. Of the 109 percutaneous transhepatic drainage patients, 58 underwent surgical treatment. Their postoperative mortality was compared with that of a control group of 65 patients, who were operated upon immediately after simple diagnostic percutaneous transhepatic cholangiography. It was not possible to demonstrate any significant difference in the postoperative mortality between these two groups. When the complications and, in addition, even mortality of the percutaneous transhepatic drainage procedure are taken into account, it seems doubtful that percutaneous transhepatic external drainage will benefit patients undergoing operation. This procedure may still be of great value in patients in whom only palliation is demanded.