PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE
BILIARY PROCEDURES
Percutaneous transhepatic biliary drainage (PTCD) is the placement of a drain into bile ducts using needles inserted through the skin. The procedure can be used to treat cholestasis (where the bile cannot flow from the liver to the small intestine), which may be a result of a narrowing or blockage in the bile ducts or of a bile leakage after an operation.
Biliary stenting is performed after biliary drainage if the blockage is malignant (cancerous) to keep the bile duct open and to allow the drain used in PTCD to be removed. This involves putting a stent (a mesh metal tube) into the bile duct, which then functions as a supportive skeleton to prevent the duct from closing.
Biliary stone extraction is carried out using percutaneous access to the biliary tree (also known as the biliary tract, this is the path by which bile travels from the liver to the small intestine). Stones can be removed using a tiny basket or with a grasping device. Small and medium-sized stones can be pushed into the first part of the small intestine using a tiny balloon. If the stones are larger than 5 mm, a tiny balloon is used to dilate the entrance to the small intestine.
PERCUTANEOUS BILIARY DRAIN & STENTING (PTBD & PTS)
Why perform it?
If you are unsuitable for endoscopic procedures, PTBD & PTS is a possible alternative for you. It can be used to decompress the biliary ducts if they are blocked by a mass lesion or a stone, or to bridge a hole if you experience bile leakage.
Benefits of IR guided procedures
51. Rapid relief from symptoms.
52. The imaging techniques allow accurate diagnosis and treatment using cutting-edge equipment. Diagnosis is reconfirmed during procedure.
53. Minimally invasive procedures are performed through a small hole in the skin, minimising the patient’s discomfort and recovery time. There won’t be any scar.
54. Most procedures can be performed on an outpatient basis or require only a short hospital stay. As interventional procedures tend to require only local anaesthesia, hospital stays are very short, with patients frequently going home the day the procedure is performed.
55. Patients who undergo IR procedures experience less pain during and after the procedure than patients undergoing surgical procedures. Post-procedural care is provided, along with follow-up imaging to confirm if the treatment has been successful.
56. Minimal damage to surrounding vital anatomical structures with no significant structural weakness.
57. No or negligible blood loss. No requirement of blood transfusion.
58. Return to work and other normal activities usually within the first few days after the procedure.
59. Low risk compared to surgery. The techniques can be used in very sick patients who are unfit for surgery.
60. Overall procedure is less expensive than surgery or other alternatives.
How will you prepare for procedure:
Procedure will be done as a day case procedure, only rarely would you need to stay overnight.
• You will have had some blood tests performed before the procedure to check that you do not have an increased risk of bleeding.
• You are asked not to eat for 4 hours prior to the procedure. You may drink a little water.
• You will need someone to drive you home and to look after you for 24 hours.
• You should be prepared to stay overnight if necessary.
• If you have any allergies or you have previously reacted to intravenous contrast medium, you must let the doctor know. Intravenous contrast medium is the injection we give you during some scans.
• If you are diabetic, please contact IR coordinator at 0328 0177770 for further information
• If you normally take any medication to thin your blood (anticoagulation or antiplatelet drugs) such as: warfarin / clopidogrel / aspirin, dabigatran (Pradaxa) / rivaroxiban (Xarelto) / Apixaban (Eliquis) / phendione / acenocoumarol – then these may need to be stopped or altered. Please contact the contact IR coordinator at 0328 0177770 for further information
How long will it take?
Every case is different, and it is difficult to predict exact time it will take. Procedure will be carried out in image guidance and roughly takes an hour or so.
What Happens afterward?
You will be observed in a post-operative facility for 2 to 4 hrs and if all observations are satisfactory, you will be discharged home the same day. It is natural to feel tired after the procedure and light bed rest for a couple of days is recommended.
