The most common biliary interventions performed in our department is biliary drainage. This is done in cases of obstruction of the bile ducts that may be due to malignancy or benign disease.
The procedure is done under general anaesthetic. A thin needle is placed through the skin and liver into a bile duct under ultrasound guidance. Iodine contrast is injected through the needle and radiographs are obtained to demonstrate the bile ducts as well as the location and appearance of the obstructing lesion. A guide wire is then placed over the narrowed segment into the small intestine. We can then place a metallic stent or a plastic drainage tube over the obstructing lesion.
Metallic biliary stenting
This is placement of a permanent metallic stent between the bile ducts and the small intestine (duodenum), usually used in the context of proven and inoperable malignancy where this is a palliative procedure to facilitate drainage of bile and alleviate symptoms of obstructive jaundice. This is very convenient as there is no post procedure wound care, but patients should contact the treating doctor if jaundice recurs.
Advantages of metallic stents
There is no external component and no wound care is required.
Occlusion of the stent is difficult to manage and requires endoscopic removal. If tumour grows through the stent it may be impossible to remove.
Endo/exo biliary prosthesis
This is a plastic drainage tube that is placed through the skin, traversing the liver and bile ducts with the distal end in the duodenum. There are multiple side holes in the tube that enable bile to drain from the bile ducts into the small intestine. The proximal end remains outside the body where it is adhered to the skin. No external drainage occurs and the proximal tube allows future access as well as flushing of the tube.
Advantages of endo/exo drainage
In the event of occlusion/blockage the tube can easily be flushed or replaced.
The external tube with the dressing is inconvenient and does require replacement of dressings from time to time. Inefficient forward drainage or obstruction may result external bile drainage. The plastic tube needs to be replaced every six weeks to prevent infection.
Endo/exo tube wound care
Endo/exo drainage tubes are used to aid bile drainage into the intestines due to a narrowing that stops the bile from draining naturally.
Steps to follow to prevent blockage of the endo/exo tubes and wound infection
Bile drainage could be green, yellow or brown in colour and may have an offensive smell
The following procedure should be carried out if drainage is noted on the wound dressing & to prevent blockage of the drainage tube: