The liver makes bile which helps in digestion of the fats. The bile passes through a series of small tubes called ducts that drain into a large duct, called the common bile duct. The common bile duct empties into the first part of the small bowel called duodenum. The bile produced in the liver is also stored in the gallbladder. If the bile duct gets blocked, the bile cannot drain normally and gets collected before the site of the blockage. The signs of blocked bile ducts are jaundice, dark urine, chalk colored stools, itching, nausea, and loss of appetite. This condition is potentially serious and needs to be treated.
Obstruction in common bile duct can be an indication of many problems which may include benign growth or cancers like cancer of bile duct, cancer of gall bladder etc. Many a times these tumours or obstructions cannot be approached through surgery as they have either grown in size or are already in advanced stage. Percutaneous Transhepatic Biliary Drainage is an alternative procedure for patients where the procedures like ERCP is not effective. If liver is more than 50% obstruction then it becomes necessary to perform the PTBD surgery else the patient could go into liver failure.
PTBD is an image-guided procedure which can be performed under fluoroscopy or combined ultrasound and fluoroscopic guidance. Its indications are varied including both obstructive as well as nonobstructive etiologies. The obstruction in the biliary area could be either high or low. Low bile duct obstruction occurs when the obstruction is below the insertion of the cystic duct.Whereas the high bile duct obstruction occurs when the obstruction occurs at or above the common hepatic duct.
The procedure can be performed in following cases:
To regulate bilrubin in case of cancer patients
To access biliary system for further palliative interventions such as stent placement
PTBD in India is mostly preferred and gives best results in case of high bile duct obstruction.
In percutaneous transhepatic biliary drainage (PTBD) a small, flexible, plastic tube is placed through the skin into the liver to drain a blocked bile duct system. Ultrasound and x-ray of the abdomen locate the blockage of bile flow. Based on the ultrasound images a small plastic or metal tube (stent) in the liver to drain bile is placed. The bile drains through the stent into the small bowel or in a collection bag outside the body. This procedure may relieve the obstruction symptoms before surgery is done.
As such it is very successfully done in India for patients with gall stones,pancreatitis, cholangitis, perforation, cholangitis, and CBD perforation. However it is avoided in patients with:
Multiple liver obstruction
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