Hepatobilliary drains

Introduction

Liver is the organ where bile is produced. Then bile is carried through the bile duct to the gall bladder which is the organ where bile is stored .Various stimuli (CCK, presence of food in the gut) can evoke contraction of the gallbladder. These contractions drive bile to the duodenum from gall bladder via common bile duct. More than 90% of the bile is reabsorbed to the blood and rest excretes via faeces. This is the normal bile pathway.

If there is an obstruction to this bile pathway, patient may need bile drainage. Obstruction could be due to gall stones, cancers or strictures.

Obstruction can be in the common hepatic duct, bile duct, common bile duct, etc. To relieve the obstruction, bile drainage may be required.

Drainage procedures are indicated in cases where the bile duct is:

1. Very dilated

2. Contains multiple stones

3. Drains poorly

4. Has a stone that is impacted at the lower end and all efforts to remove it have failed

5. Difficult to totally clear for any reason.

6. Following bile duct exploration

Drainage procedures are especially useful in the elderly and include a choledocho-duodenostomy or transduodenal sphinc­teroplasty. The former procedure, which involves anastomosing the duodenum to the opened duct, is safe as long as the duct is dilated.

Common draining methods

1. Percutaneous transhepatic drainage

2. Endoscopic biliary drainage

3. T-tube drainage.

4. Drainage with pigtail stent for large retained stones