SURGEON PERFORMED PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE- OUR EXPERIENCE.
EAES Academy. Kumar N. 07/05/22; 363055; P099
Dr. Neha Kumar
Contributions
Contributions
Abstract
Introduction:
Percutaneous transhepatic biliary drainage (PTBD) is an effective method to treat biliary obstruction especially in cases where endoscopic drainage modalities are unsuccessful. The main concern with PTBD is the high complication rate (up to 10% complication with a procedure related mortality rate of 0.8%). PTBD also needs to be performed by someone with the correct training, and this is usually an interventional radiologist. At our center, there is very limited access to interventional radiology, majority of PTBDs are performed by surgeons.
Methods:
A retrospective review of a prospectively maintained database was carried out from January 2019- November 2021 was carried. All PTBDs performed at a single referral center (Dr George Mukhari Academic Hospital) were analysed. The procedures were analysed in two groups based on whether they were performed by the surgical team or the interventional radiologist to allow for direct comparison. Primary outcomes of interest were technical success and post procedure adverse events. Secondary outcomes of interest included clinical success and length of hospital stay. All complications were reported using the Clavien-Dindo scoring system.
Results:
During the period specified, a total of 41 consecutive patients underwent PTBD. 33 (80%) patients had the PTBD performed by the surgical team and 8 (20%) patients has the procedure performed by interventional radiology. PTBD was successful in 39/41 patients (95%). The success rate was equivalent in procedures performed by the surgical team vs the radiology team (p=0.61). In 11/41 patients (27%) procedure related complications were observed. Majority of the complications were Grade II (AKI) and seen in 22% of patients. Major complications (noted as Clavien-Dindo III and higher) occurred in 5/41 patients (12%). Procedures performed by surgical team had equivalent rates of complications compared to those performed by radiology team (4% vs 5%, respectively [p=0.21]). With respect to the prosthesis related complications, particularly slipped drains, these occurred in 3/41 patients (7%).
Conclusion:
Surgeon performed PTBD, in our setting, is a feasible option considering the resource limitations. The PTBD procedure has a high morbidity rate particularly regarding AKI in our patients with limited access to health care and resources.
Percutaneous transhepatic biliary drainage (PTBD) is an effective method to treat biliary obstruction especially in cases where endoscopic drainage modalities are unsuccessful. The main concern with PTBD is the high complication rate (up to 10% complication with a procedure related mortality rate of 0.8%). PTBD also needs to be performed by someone with the correct training, and this is usually an interventional radiologist. At our center, there is very limited access to interventional radiology, majority of PTBDs are performed by surgeons.
Methods:
A retrospective review of a prospectively maintained database was carried out from January 2019- November 2021 was carried. All PTBDs performed at a single referral center (Dr George Mukhari Academic Hospital) were analysed. The procedures were analysed in two groups based on whether they were performed by the surgical team or the interventional radiologist to allow for direct comparison. Primary outcomes of interest were technical success and post procedure adverse events. Secondary outcomes of interest included clinical success and length of hospital stay. All complications were reported using the Clavien-Dindo scoring system.
Results:
During the period specified, a total of 41 consecutive patients underwent PTBD. 33 (80%) patients had the PTBD performed by the surgical team and 8 (20%) patients has the procedure performed by interventional radiology. PTBD was successful in 39/41 patients (95%). The success rate was equivalent in procedures performed by the surgical team vs the radiology team (p=0.61). In 11/41 patients (27%) procedure related complications were observed. Majority of the complications were Grade II (AKI) and seen in 22% of patients. Major complications (noted as Clavien-Dindo III and higher) occurred in 5/41 patients (12%). Procedures performed by surgical team had equivalent rates of complications compared to those performed by radiology team (4% vs 5%, respectively [p=0.21]). With respect to the prosthesis related complications, particularly slipped drains, these occurred in 3/41 patients (7%).
Conclusion:
Surgeon performed PTBD, in our setting, is a feasible option considering the resource limitations. The PTBD procedure has a high morbidity rate particularly regarding AKI in our patients with limited access to health care and resources.
Introduction:
Percutaneous transhepatic biliary drainage (PTBD) is an effective method to treat biliary obstruction especially in cases where endoscopic drainage modalities are unsuccessful. The main concern with PTBD is the high complication rate (up to 10% complication with a procedure related mortality rate of 0.8%). PTBD also needs to be performed by someone with the correct training, and this is usually an interventional radiologist. At our center, there is very limited access to interventional radiology, majority of PTBDs are performed by surgeons.
Methods:
A retrospective review of a prospectively maintained database was carried out from January 2019- November 2021 was carried. All PTBDs performed at a single referral center (Dr George Mukhari Academic Hospital) were analysed. The procedures were analysed in two groups based on whether they were performed by the surgical team or the interventional radiologist to allow for direct comparison. Primary outcomes of interest were technical success and post procedure adverse events. Secondary outcomes of interest included clinical success and length of hospital stay. All complications were reported using the Clavien-Dindo scoring system.
Results:
During the period specified, a total of 41 consecutive patients underwent PTBD. 33 (80%) patients had the PTBD performed by the surgical team and 8 (20%) patients has the procedure performed by interventional radiology. PTBD was successful in 39/41 patients (95%). The success rate was equivalent in procedures performed by the surgical team vs the radiology team (p=0.61). In 11/41 patients (27%) procedure related complications were observed. Majority of the complications were Grade II (AKI) and seen in 22% of patients. Major complications (noted as Clavien-Dindo III and higher) occurred in 5/41 patients (12%). Procedures performed by surgical team had equivalent rates of complications compared to those performed by radiology team (4% vs 5%, respectively [p=0.21]). With respect to the prosthesis related complications, particularly slipped drains, these occurred in 3/41 patients (7%).
Conclusion:
Surgeon performed PTBD, in our setting, is a feasible option considering the resource limitations. The PTBD procedure has a high morbidity rate particularly regarding AKI in our patients with limited access to health care and resources.
Percutaneous transhepatic biliary drainage (PTBD) is an effective method to treat biliary obstruction especially in cases where endoscopic drainage modalities are unsuccessful. The main concern with PTBD is the high complication rate (up to 10% complication with a procedure related mortality rate of 0.8%). PTBD also needs to be performed by someone with the correct training, and this is usually an interventional radiologist. At our center, there is very limited access to interventional radiology, majority of PTBDs are performed by surgeons.
Methods:
A retrospective review of a prospectively maintained database was carried out from January 2019- November 2021 was carried. All PTBDs performed at a single referral center (Dr George Mukhari Academic Hospital) were analysed. The procedures were analysed in two groups based on whether they were performed by the surgical team or the interventional radiologist to allow for direct comparison. Primary outcomes of interest were technical success and post procedure adverse events. Secondary outcomes of interest included clinical success and length of hospital stay. All complications were reported using the Clavien-Dindo scoring system.
Results:
During the period specified, a total of 41 consecutive patients underwent PTBD. 33 (80%) patients had the PTBD performed by the surgical team and 8 (20%) patients has the procedure performed by interventional radiology. PTBD was successful in 39/41 patients (95%). The success rate was equivalent in procedures performed by the surgical team vs the radiology team (p=0.61). In 11/41 patients (27%) procedure related complications were observed. Majority of the complications were Grade II (AKI) and seen in 22% of patients. Major complications (noted as Clavien-Dindo III and higher) occurred in 5/41 patients (12%). Procedures performed by surgical team had equivalent rates of complications compared to those performed by radiology team (4% vs 5%, respectively [p=0.21]). With respect to the prosthesis related complications, particularly slipped drains, these occurred in 3/41 patients (7%).
Conclusion:
Surgeon performed PTBD, in our setting, is a feasible option considering the resource limitations. The PTBD procedure has a high morbidity rate particularly regarding AKI in our patients with limited access to health care and resources.
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