When a person is experiencing blockages or other complications in the bile ducts, a Percutaneous Transhepatic Biliary Drainage (PTBD) procedure may be necessary to help diagnose and treat the issue.
Percutaneous Transhepatic Biliary Drainage (PTBD) procedure involves inserting a thin catheter into the liver through an incision in the abdomen and then threading it through the bile ducts to access blocked areas. By doing this, physicians can drain fluid or bile from the liver, relieving pressure and/or allowing medication to be delivered directly to the area of obstruction.
|Procedure Name||Percutaneous Transhepatic Biliary Drainage|
Gallstones, Tumours, Pancreatic cancer, Biliary strictures, Pancreatic pseudocyst, Malignant biliary cancers, Chronic pancreatitis
|Benefits of Procedure||
Less invasive than other biliary procedures, Faster recovery time, More accurate diagnosis, Improved prognosis, Lower risk of complications
|Treated By||Interventional Radiologist|
What is Percutaneous Transhepatic Biliary Drainage (PTBD) Procedure?
Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure performed to drain the fluid or bile from the gallbladder, pancreas, and bile ducts using a tube inserted through the skin and into the biliary system. The procedure treats various conditions, including jaundice, bile duct stones, pancreatitis, and bile leakage.
Anatomy And Physiology Of The Biliary System
- The biliary system is a network of organs and ducts that work together to produce, store, and secrete bile. Bile is a yellowish-green fluid that helps the body break down fats in the intestine.
- The main organs of the biliary system are the liver, gallbladder, and pancreas. The liver produces bile, which is stored in the gallbladder. The pancreas also produces enzymes that help break down fats in the intestine.
- The liver breaks down red blood cells to produce bile. Bile comprises water, electrolytes, cholesterol, bile acids, and pigments. The liver excretes bile through the hepatic ducts into the common hepatic duct. From there, it flows into the cystic duct and then into the gallbladder for storage.
- When fat enters the small intestine, it stimulates the contraction of the gallbladder and the release of stored bile into the cystic duct and common hepatic duct. Bile flows from these ducts into the main pancreatic duct and eventually into the small intestines, where it aids in the digestion of fat.
Conditions treated with PTBD Procedure
Percutaneous Transhepatic Biliary Drainage (PTBD) is a procedure that diagnoses and treats specific conditions related to the biliary system. It is mainly used to treat conditions that are causing blockages or obstructions in the biliary tree, such as:
- Gallstones: If a person has gallstones that block bile flow, PTBD can be used to clear them away. It can also be used to treat gallbladder inflammation and infection.
- Tumours: PTBD can help diagnose tumours of the biliary tree and remove them if necessary.
- Pancreatic cancer: In some cases, a PTBD procedure can relieve pressure or reduce the risk of complications.
- Biliary strictures: PTBD can widen narrow areas in the biliary tree caused by scarring or inflammation.
- Pancreatic pseudocyst: If a cyst forms in the pancreas, PTBD can drain it and relieve pressure. A radiologist usually performs the procedure.
- Malignant biliary cancers: In the case of biliary cancers, PTBD can be used to relieve symptoms and reduce the risk of complications.
- Chronic pancreatitis: PTBD can treat chronic pancreatitis, which causes pancreas inflammation.
- Biliary strictures: PTBD can widen narrow areas in the biliary tree caused by scarring or inflammation.
- Bile duct infection: Bile duct infection is uncommon but potentially dangerous. PTBD can be used to flush out the infection and provide relief.
While PTBD is a safe procedure, it is essential to speak with your doctor before undergoing the process to discuss the risks and benefits. Your doctor can determine if PTBD is the right treatment for your condition.
Who needs PTBD Procedure?
The PTBD procedure is not suitable for everyone. It's generally recommended for people with blocked bile ducts and those with liver cancer or gallstone complications. It's a highly technical medical procedure which can be performed by someone who should only do it with the appropriate medical qualifications and experience.
The ideal candidates for the PTBD procedure:
- Patients with complications from gallstones.
- Patients with liver cancer.
- Patients with blocked bile ducts.
- Patients undergoing chemotherapy.
Who are not suitable for PTBD procedure?
- Patients with severe liver disease.
- Patients who are pregnant.
- Patients who are allergic to the medications used during the procedure.
- Patients who are too weak to withstand the procedure.
It's important to remember that every patient is different, so what might be okay for one patient may not be suitable for another. That's why speaking with your doctor before considering a PTBD procedure is essential.
How is the PTBD Procedure performed?
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:
- The doctor will insert a catheter into the bile duct with an X-ray or ultrasound guidance.
- A contrast dye will be injected through the catheter to help guide the doctor.
- The contrast dye will also help the doctor identify any blockages or abnormalities in the bile ducts.
- 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.
- The tube will stay in place for several days to clear blockages and the bile ducts to heal.
- The doctor will remove the tube and catheter, allowing your bile ducts to start functioning normally again.
What to expect before and on the day of the PTBD Procedure?
Before the PTBD Procedure
- Before the PTBD procedure, the patient may be asked to undergo certain tests such as X-rays and blood tests.
- The patient will be asked to stop blood thinners or other medications.
- It is also essential for the patient to inform the doctor about any allergies that he/she may have.
- The doctor may recommend an enema to clear the intestines the day before the procedure.
- 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.
- 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
- The patient will likely be asked to fast for 8 to 12 hours before the procedure.
- An IV line will be inserted into the arm or hand, through which the patient will receive medications, such as antibiotics or pain medications.
- 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.
What to expect after the PTBD procedure?
After the PTBD procedure
- The patient may also be asked to avoid certain activities, such as heavy lifting or strenuous exercise.
- The patient needs to be aware of any signs or symptoms of complications, such as fever or abdominal pain.
- The patient should also watch for signs of infection and report it to their doctor as soon as possible.
- Lastly, the patient must contact their doctor if the patient experiences unusual or severe symptoms after the procedure.
The Recovery Process at the Hospital
- After the PTBD procedure, the patient may be monitored and reassessed overnight in the hospital to ensure the patient’s recovery.
- The recovery process will involve monitoring vital signs and regular assessments of the patient's abdominal and liver areas.
- Pain medications will be administered as needed to ensure comfort during recovery.
- 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
- Eating a healthy and balanced diet: Eating properly and avoiding processed food will help you in the long run.
- Drinking plenty of water: Water helps flush out toxins and aids digestion.
- Avoiding certain activities: The patient must avoid strenuous activities as it will reduce the recovery speed.
- Taking prescribed medications: After the PTBD procedure, the patient must take the prescribed medications as instructed by the doctor.
- 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
- The doctor will check your bile ducts to ensure they have healed properly.
- They may also take further imaging tests to check for any complications.
- The doctor may also prescribe antibiotics to help prevent infection.
- You will be asked to restrict your activities for several days following the procedure.
- You may also be asked to follow a special diet for several weeks after the procedure.
Benefits of PTBD Procedure
- 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.
- 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.
- 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.
- 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.
- 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.
Risks And Complications of PTBD procedure
As with any medical procedure, there are a few risks and possible complications associated with the PTBD procedure. These include
- Damage to the surrounding organs or tissue
- Bile leakage
- Nausea and vomiting
- Abdominal pain
Risks of Delayed PTBD Procedure
If one delays the PTBD procedure, he/she may be at risk of
- Allergic reactions due to anaesthesia
- Respiratory complications
- Biliary peritonitis: a potentially life-threatening infection.
- Bile can leak into the abdomen, leading to infection and sepsis.
- Abscess formation
Cost of Percutaneous Transhepatic Biliary Drainage (PTBD) procedure
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:
- Type of Percutaneous Transhepatic Biliary Drainage (PTBD) Procedure
- Age of the patient
- The medical condition of the patient
- The type of hospital facility availed - individual room or shared.
|Procedure Name||Cost Value|
|Percutaneous Transhepatic Biliary Drainage (PTBD) Procedure||Rs. 60,000 to Rs. 80,000|