Percutaneous biliary drainage for high obstruction

Percutaneous biliary drainage is indicated as a palliative measure for benign or malignant obstruction. Because of its inherent risks of cholangitis and sepsis, it is not the preferred procedure if endoscopic retrograde or lower morbidity surgical drainage alternatives exist. At our institution, percutaneous biliary drainage is most frequently performed in patients with high or proximal biliary obstruction involving the common hepatic duct and the ductal bifurcation. Percutaneous biliary drainage technique requires familiarity with right and left transhepatic access and placement of various types of drains as well as adjunctive procedures including balloon angioplasty and stone retrieval.