RIGHT SIDED VERSUS LEFT SIDED PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE IN THE MANAGEMENT OF MALIGNANT DISTAL BILIARY OBSTRUCTION

Introduction. Malignant distal biliary obstruction is a common manifestation of tumors of the periampullary area.
Material and methods. In Botkin hospital (Moscow) from 2010 to 2019, percutaneous biliary drainage (PBD) was performed in 348 patients with malignant distal biliary obstruction (MDBO). The patients were divided into 2 groups: group 1 — 276 right-sided PBD (RPBD); group 2 — 72 left-sided PBD (LPBD). The causes of MDBO: group 1/group 2 were pancreatic cancer 194 (70.3%)/51 (70.8%), extrahepatic cholangiocarcinoma 49 (17.7%)/12 (16.7%), MDP cancer 9 (3.3%)/3 (4.2%), metastatic cancer 24 (8.7%)/6 (8.3%). Patient characteristics: age group 1 68.2±4.1 years, group 2 71.7±5.5 years; gender (m/f) group 1 109/157, group 2 31/41; ECOG group 1 2.4±0.2 points, group 2 2.1±0.5 points; average bilirubin level group 1 251±12.8 μmol / l, group 2 236±22.3 μmol / l. The duration of procedure: group 1 28.4±4.1 min, group 2 — 42.1±8.3 min (p=0.041). Clinical success 227 (82.2%) RPBD and 63 (87.5%) LPBD (p=0.122). The pain syndrome was higher in patients of group 1 (p=0.039). Complications developed in 85 (30.8%) patients in the RPBD group and in 27 (37.5%) in the LPBD group (p=0.308).
Discussion. Were no significant differences found in the duration of fluoroscopy, total bilirubin and postoperative complications. The duration of the procedure in the group LPBD was higher (p=0.041). The negative change in the quality of life (according to the global and functional scales p=0.045 and 0.036, respectively) was higher in the group RPBD.
Conclusion. Antegrade external drainage of the bile ducts is a highly effective procedure for decompression of the biliary tract in ZDBO.

1. Fernandez Y Viesca M., Arvanitakis M. Early Diagnosis And Management Of Malignant Distal Biliary Obstruction: A Review On Current Recommendations And Guidelines. Clin. Exp. Gastroenterol. 2019, 12, pp. 415−432. http://doi.org/10.2147/CEG.S195714

2. Kim Y., Cha S. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach. J. Korean Radiol. Soc., 2002, 46, pp. 115–118.

3. Rivera-Sanfeliz G., Assar O., LaBerge J., Wilson M., Gordon R., Ring E., Kerlan R. Incidence of important hemobilia following transhepatic biliary drainage: leftsided versus right-sided approaches. Cardiovasc. Intervent. Radiol., 2004, 27, pp. 137–139. http://doi.org/10.1007/s00270-003-0022-0

4. Castiglione D., Gozzo C., Mammino L., Failla G., Palmucci S., Basile A. Health-Related Quality of Life evaluation in «left» versus «right» access for percutaneous transhepatic biliary drainage using EORTC QLQBIL-21 questionnaire: a randomized controlled trial. Abdom. Radiol. (NY)., 2020, 45, pp. 1162–1173. http://doi.org/10.1007/s00261-019-02136-7

5. Karcioglu O., Topacoglu H., Dikme O., Dikme O. (2018). A systematic review of the pain scales in adults: Which to use? The American Journal of Emergency Medicine, 2018, 36(4), pp. 707–714. http://doi.org/10.1016/j.ajem.2018.01.008

6. Scott N., Fayers P., Aaronson N., Bottomley A., de Graeff A., Groenvold M., Kollerh М., Petersenf М., Mirjam A. EORTC QLQ-C30 reference values., 2008. Brussels, Belgium. http://doi.org/10.1016/j.jclinepi.2007.08.015