Percutaneous antegrade electropapillotomy. Study in dogs

Percutaneous transhepatic sphincterotomy of the major papilla and stone extraction without endoscopic control

Obstructive jaundice due to an impacted stone in the common bile duct (CBD) was seen in a patient who had previously undergone Billroth II gastric resection and cholecystectomy. Surgical and endoscopic approaches to the common bile duct failed owing to pericholedochal adhesions and the excessive length of the duodenal loop. The patient was therefore treated percutaneously (sphincterotomy and stone extraction) without endoscopic control.

Percutaneous transhepatic biliary drainage: experience with 311 procedures

Percutaneous biliary drainage was performed in 296 patients on 311 occasions using a fine-needle puncture technique. In 59%, the procedure served as postoperative decompression, and in 35% for palliation of obstruction, particularly in malignant disease. Postoperative drainage for the management of postoperative complication accounted for 2.5%. In more than 80% of the patients treated, the underlying disease was malignant obstructive jaundice. In 257 retrospectively evaluated patients the following complications were observed: cholangitis (6.6%), sepsis (3.1%), bile leakage (1.6%) with two deaths (0.7%), and subcapsular hematoma and hematoma in the hepatoduodenal ligament (1.2%). Catheter dislocations accounted for 8.5% and were eliminated by the use of self-retaining catheters. In 51 prospectively studied patients pain was encountered in 55% and cholangitis in 11.8%. The procedure is most valuable for complicated biliary obstruction, palliative drainage, and endobiliary manipulations.