US-GUIDED LEFT-SIDED BILIARY DRAINAGE - 9-YEAR EXPERIENCE

PURPOSE: The feasibility and safety of left-sided biliary drainage wit h ultrasound (US) guidance were studied prospectively. MATERIALS AND M ETHODS: From July 1987 to July 1996, 208 consecutive patients underwen t US-guided biliary drainage; all were evaluated for left-sided draina ge. Drainage procedure was begun with puncture of the hepatic duct bra nch of the lateral segment of the left lobe when the branch was well v isualized with US; otherwise, a right-sided approach was used. When th e hepatic duct branch diameter was greater than 3 mm, puncture was per formed with an 18-gauge needle; smaller branches were punctured with 2 1-gauge needles. RESULTS: In 147 (71%) patients, the left hepatic duct branch was well visualized with US, and the branch diameter was great er than 3 mm. In these patients, left-sided drainage with use of an 18 -gauge needle was successful. In 26 (12%) patients, the left hepatic d uct branch diameter was less than 3 mm, and drainage was initiated wit h a 21-gauge needle. In six (23%) of these 26 patients, left-sided dra inage was unsuccessful, but five of these patients underwent successfu l US-guided drainage from the right hepatic duct branch. Two patients died of septic shock within 72 hours of completed drainage. Three pati ents experienced severe hemobilia. CONCLUSION: US-guided left-sided bi liary drainage is a highly successful and safe method when the left he patic duct branch diameter is greater than 3 mm.