Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic
bile duct obstruction, but with technological advancements, percutaneous transhepatic
drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative.
Endoscopic methods may lead to a decreasing indication of PTD in the future, but today
it is still the standard treatment method, especially in hilar obstructions.In our
retrospective data analysis, we assessed technical success rate, reintervention rate,
morbidity, mortality, and the learning curve of patients treated with PTD over 12
years in a tertiary referral center.599 patients were treated with 615 percutaneous
interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention
rate were achieved. 111 minor and 22 major complications occurred including 1 case
of death. In perihilar obstruction, cholangitis were significantly more frequent in
cases where endoscopic retrograde cholangiopancreatography had also been performed
prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively.The
results and especially the excellent success rates demonstrate that PTD is safe and
effective, and it is appropriate for first choice in the treatment algorithm of perihilar
stenosis. Ultimately, we concluded that PTD should be performed in experienced centers
to achieve low mortality, morbidity, and high success rates.
