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Prospective Comparison of Bleeding Complications Between Right and Left Approaches in Percutaneous Biliary Drainage

Houghton, Eduardo J., MD*,†,‡; Zeledón, Manuel, MD, PhD§; Acquafresca, Pablo, MD; Finger, Caetano, MD†,∥; Palermo, Mariano, MD, PhD*,†; Giménez, Mariano E., MD, PhD*,†

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: February 2019 - Volume 29 - Issue 1 - p 7–12
doi: 10.1097/SLE.0000000000000609
Original Articles
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Purpose: The present study aimed to determine whether the percentage of bleeding complications differs between the right and the left approaches in percutaneous biliary drainage (PBD) in adult patients.

Materials and Methods: This was a prospective, descriptive, nonrandomized comparative and longitudinal study. We included adult patients over 18 years of age who underwent a PBD. We excluded those with a bilateral PBD for the comparative study. Usually, but not exclusively, we performed the right approach under fluoroscopic guidance and the left one under ultrasound and fluoroscopy.

Results: Of 150 cases, 63 were performed using the right approach and 61 with the left; 26 were performed with the bilateral. The right approach faced less dilated biliary ducts and more benign diseases. We experienced 20 bleeding complications (13.33%, confidence intervals of 95%=8.3-19.8), 7 in the bilateral approach, 10 in the right approach, and 3 in the left one. The difference between the right and the left approaches was statistically significant (Fisher P=0,04). No procedures were required to obtain hemostasis, and only one patient (0.66%, confidence intervals of 95%=0.009-3.66) (in the right side) required a red blood cell transfusion. We found no related mortality.

Conclusions: Global bleeding complications are more likely to appear in the right approach in which less dilated biliary ducts and more benign diseases probably contributed to a higher number of needle passes, portal and hepatic vein punctures, and, therefore, to an increase in the risk of bleeding complications. The significant bleeding complication rate was low (0.66%).

*Department of Surgery, University of Buenos Aires

DAICIM Foundation, Teaching Assistance and Research in Mini-invasive Surgery

Hospital Bernardino Rivadavia

§Department of Surgery, University of Costa Rica, San Jose

Hospital Juan A. Fernández, Buenos Aires, Argentina

All procedures performed in studies involving human participants were by the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This protocol is part of a larger one presented at the Ethics Committee of the Rivadavia Hospital by the principal investigator: “Safety standards for reducing bleeding complications of percutaneous biliary drainage.” The approval ID number was: 289/15.

This research respected and complied with all laws and regulations relevant to this study, which adheres to the CIS by Manual Operating Procedures into effect at the time of execution of this research.

The confidentiality of personal information recorded in the medical history (or registration form or questionnaire or form) was respected. The researchers implemented methods that allowed coding of subjects and enabled them to dissociate their identifying personal data from scientific data, pledging to protect any information arising from the recollection, use, and transfer of data, depending on the terms of Law 1845 (Law of protection of personal data in force in the City of Buenos Aires).

The authors declare no conflicts of interest.

Reprints: Eduardo J. Houghton, MD, Hospital Bernardino Rivadavia, Las Heras 2670, Buenos Aires, Argentina (e-mail: ehoughton26@icloud.com).

Received February 23, 2018

Accepted October 19, 2018

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