ORIGINAL ARTICLES   

Chirurgia 2000 June;13(3):141-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Ultrasound guided biliary drainage: a minimally invasive procedure for the treatment of neoplastic inoperable biliary obstructions

Piccolboni D., Settembre A., Cuccurullo D., Pirozzi F., Famiani M., Corcione F.

Background. The purpose of this work was to evaluate the indications to the use of percutaneous biliary drainage (PTBD) for the treatment of inoperable liver hilum neoplasms. When major surgery proves feasible only in 30-60% of cases, for the particular anatomic seat and often for late diagnosis, and palliative surgery is doomed by relevant complications (12-60%) and mortality (7-10%), the positioning of PTBD is a scarcely invasive procedure, requested for the light stress induced in the jaundiced patient, and for the relatively poor complications (15% on average for fluoroscopic technique) and related mortality, variable from 1 to 5.6% in the literature.
Methods. Our clinical experience, at the Department of General Surgery in Monaldi Hospital, Naples, consists of 16 cases, treated over the last three years, with ultrasonic guidance only.
Results. Among these, eight were Klatskin tumours, involving the biliary confluence and pedicular vessels, two cases were of pancreatic head tumors, with hepatic or pedicular involvement, in which endoscopic drainage proved to be impossible, six cases were of cholecystic tumours, with infiltration of the hepatic hilum. Ultrasonic guidance and the utilization of an armed, polyethilene 7F catheter, made the procedure simpler and safer, avoiding major complications and related mortality, reducing the incidence of minor complications (37.5%).
Conclusions. Ultrasound-guided percutaneous drainage is considered as a valid therapeutic option when a surgical approach is not advisable or impossible, because of neoplastic diffusion or poor patient conditions.