Percutaneous Transhepatic Biliary Drainage (PTBD) Procedure

Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure that can be used to treat blocked bile ducts. The procedure is usually done under local anaesthesia and sedation. PTBD Procedure is an outpatient procedure. Here are the steps of the procedure broken down into easy-to-understand bullets:

Steps the doctor will perform during the surgery:

1. The doctor will insert a catheter into the bile duct with an X-ray or ultrasound guidance.
2. A contrast dye will be injected through the catheter to help guide the doctor.
3. The contrast dye will also help the doctor identify any blockages or abnormalities in the bile ducts.
4. The doctor will insert a drainage tube into the catheter and attach it to a bag that will collect any bile secreted through the tube.
5. The tube will stay in place for several days to clear blockages and the bile ducts to heal.
6. The doctor will remove the tube and catheter, allowing your bile ducts to start functioning normally again.

Before the PTBD Procedure

1. Before the PTBD procedure, the patient may be asked to undergo certain tests such as X-rays and blood tests.
2. The patient will be asked to stop blood thinners or other medications.
3. It is also essential for the patient to inform the doctor about any allergies that he/she may have.
4. The doctor may recommend an enema to clear the intestines the day before the procedure.
5. The patient must arrange for a friend or family member to drive home after the PTBD procedure, as the patient may experience some drowsiness from the anaesthesia.
6. It is essential to discuss the risks of the procedure with the doctor before the procedure so that the patient can weigh the risks and benefits. The doctor can also explain the steps to prevent or reduce these complications.

On the day of the PTBD procedure

1. The patient will likely be asked to fast for 8 to 12 hours before the procedure.
2. An IV line will be inserted into the arm or hand, through which the patient will receive medications, such as antibiotics or pain medications.
3. After the procedure, it is recommended to rest in bed and drink plenty of fluids. The doctor will provide specific instructions for follow-up care.

After the PTBD procedure

1. The patient may also be asked to avoid certain activities, such as heavy lifting or strenuous exercise.
2. The patient needs to be aware of any signs or symptoms of complications, such as fever or abdominal pain.
3. The patient should also watch for signs of infection and report it to their doctor as soon as possible.
4. Lastly, the patient must contact their doctor if the patient experiences unusual or severe symptoms after the procedure.

The Recovery Process at the Hospital

1. After the PTBD procedure, the patient may be monitored and reassessed overnight in the hospital to ensure the patient’s recovery.
2. The recovery process will involve monitoring vital signs and regular assessments of the patient's abdominal and liver areas. 
3. Pain medications will be administered as needed to ensure comfort during recovery.
4. During recovery, following the doctor's instructions for rest and taking medications as prescribed is essential. However, some may need to stay in the hospital for an additional day or two if they experience complications.

Recovery process/expectation after hospital discharge

1. Eating a healthy and balanced diet: Eating properly and avoiding processed food will help you in the long run.
2. Drinking plenty of water: Water helps flush out toxins and aids digestion.
3. Avoiding certain activities: The patient must avoid strenuous activities as it will reduce the recovery speed. 
4. Taking prescribed medications: After the PTBD procedure, the patient must take the prescribed medications as instructed by the doctor.
5. Following up with your doctor: After the PTBD procedure, the patient must follow up regularly with the doctor to monitor his/her progress and recovery.

First follow-up appointment

1. The doctor will check your bile ducts to ensure they have healed properly.
2. They may also take further imaging tests to check for any complications.
3. The doctor may also prescribe antibiotics to help prevent infection.
4. You will be asked to restrict your activities for several days following the procedure.
5. You may also be asked to follow a special diet for several weeks after the procedure.

1. Less invasive than other biliary procedures: PTBD is minimally invasive and only requires a small incision in the skin. It can be performed under local anaesthesia, reducing the discomfort experienced during and after the procedure.
2. Faster recovery time: Since it is a minimally invasive procedure, it requires less time for recovery, and patients can often return to their normal routine within a few days.
3. More accurate diagnosis: PTBD can help provide a more accurate diagnosis of biliary diseases and conditions. It is especially helpful in determining the cause of bile duct blockage or narrowing.
4. Improved prognosis: It can also improve the prognosis for patients who suffer from biliary diseases, as it can help to diagnose and treat the condition quickly.
5. Lower risk of complications: PTBD has a lower risk of complications than other biliary procedures, as there is less risk of infection or bleeding due to the nature of the incision.

As with any medical procedure, there are a few risks and possible complications associated with the PTBD procedure. These include 

1. Bleeding
2. Infection
3. Damage to the surrounding organs or tissue
4. Bile leakage
5. Nausea and vomiting
6. Abdominal pain
7. Diarrhoea
8. Fever

If one delays the PTBD procedure, he/she may be at risk of 

1. Allergic reactions due to anaesthesia
2. Respiratory complications
3. Biliary peritonitis: a potentially life-threatening infection. 
4. Bile can leak into the abdomen, leading to infection and sepsis. 
5. Bleeding
6. Abscess formation

The cost of  Percutaneous Transhepatic Biliary Drainage (PTBD) procedure ranges from Rs. 60,000 to Rs. 80,000. The cost varies based on the following factors:

1. Type of Percutaneous Transhepatic Biliary Drainage (PTBD) Procedure
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.